Effects of Income Inequality on Quality of Healthcare Essay

Positive rights are rights that everyone is entitled to including: the right to a public education, access to public roads, and the right to health care. There are no guarantees when it comes to life, but having health insurance makes a huge difference with preventing, diagnosing, and treating diseases. Of course having insurance itself is a great resource to ensure medical care and containing costs, but not all insurance programs are created equal. Insurance programs have caveats, exclusions, varying co-payments, and access to certain doctors and hospitals, which creates an ethical dilemma. Receiving the best care is subjective in most cases, but with money you can buy almost anything, including the best care. Although those living in poverty are given access to healthcare, that does not mean they receive the best or equal care as those who are wealthy.Effects of Income Inequality on Quality of Healthcare Essay

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

Living in a capitalist society, the richest Americans enjoy larger homes, nicer cars, better education and even health care. Even if we lived in a capitalist society where everyone had access to the same basic healthcare program, the rich would still be able to afford better care. The wealthy are able to pay more in co-payments, prescription costs, and the ability to go outside of the healthcare system in this country to seek help. When you have the disposable resources then the sky is the limit, where the poor have very limited options. They will be confined to their healthcare coverage program and do not have the luxury of seeking additional assistance. “Poor patients often receive less quality care in the hospital, have more barriers to recovery, and experience higher morbidity and mortality than do patients with higher incomes” (Dracup).Effects of Income Inequality on Quality of Healthcare Essay

Income inequality also causes obesity however; we mostly blame individuals for being obese. Being obese can have a serious impact on mental and physical health. it is an illness that is associated with stereotypes. The biggest one is “if poor people become obese they cannot be not poor”. People in this mentality also exclude the structural and social conditions that cause illnesses such as obesity. Social life affects the health of people, especially the socioeconomic level. How much you earn monthly is a factor how fit you are. The risk of being an obese is lower for the wealthy individuals. Poor people are obese because they have no money to buy healthy food, they have no time to exercise, they have stress that causes them to eat constantly, they lack education, they do not have access to the healthcare, they do not have social support and so on. It is mostly about the income inequality.

Any observant person understands that one’s position in life and the adversities associated with poverty, ignorance, and powerlessness erode health and shorten life. By the middle of the nineteenth century there were already careful, detailed inquiries in England, France, Germany, and the United States on how the conditions of the poor cut life short. Edwin Chadwick, in his report on sanitary conditions in England, noted that in London’s Bethnal Green mechanics, servants, and laborers and their families died at an average age of sixteen, whereas gentlemen and professionals died at an average age of forty-five. 1 John Griscom, a physician at the New York Hospital, noted in a comparable investigation of the laboring population of New York in 1845, “The rich…live in larger houses, with freer ventilation, and upon food better adapted to support health and life. Their means of obtaining greater comforts and more luxuries, are to them, though perhaps unconsciously, the very reason of their prolonged lives.” Effects of Income Inequality on Quality of Healthcare Essay

Thousands of studies since then have confirmed and elaborated such observations. Almost every outcome conceivable—from fetal wastage and perinatal mortality, infant mortality, developmental problems, disability, distress, and longevity—has been found to be associated with social position. There has been a recent outpouring of publications on the topic. I focus here on a British inquiry on inequalities in health and four collections of papers and essays published in the United Kingdom, the United States, and Canada, but my larger goal is to explore the importance of social class and other social determinants of health and to suggest ways of improving health. Effects of Income Inequality on Quality of Healthcare Essay

There is a large and growing body of literature exploring the apparently negative effects of income inequality on health. As long ago as the 1970s, researchers reported associations, at the population level, between measures of health, such as life expectancy and infant mortality, and income inequality, as measured by indices such as the Gini coefficient. These researchers emphasized that such a relationship might simply reflect a nonlinear association between health and income at the individual level (cf 25); that is, rising income allows people to purchase more and/or better-quality goods and services that are beneficial to health, but the opportunities to do so diminish as incomes increase.Effects of Income Inequality on Quality of Healthcare Essay

More recently, however, it has been suggested that the population-level relationship between health and income inequality may reflect other causes. Income inequality may reflect social cohesion or social capital, and health at the individual level may not respond simply to absolute income but also to relativities in society, such as relative deprivation, relative income, and relative social status. Income inequality at the population level may be important because it accentuates these relativities and hence has a negative impact on health at the individual level.

A great deal of effort is now being directed at exploring the relationship between income inequality and health. Our focus is principally on literature that brings empirical evidence to bear on this thesis. Some of this work involves a reinterpretation of the population-level evidence on income inequality and health outcomes, which sometimes involves linking that evidence to other evidence at the population or individual level. Much of it, however, has involved the production of new results, at the individual level or at some intermediate level between individual and population that we somewhat loosely call the community level. “Community” can refer to a county, a state, a region, or, in principle, an area even smaller than a county.Effects of Income Inequality on Quality of Healthcare Essay

Our aim is to provide a critical assessment of the empirical literature in this field. The review is not critical of the thesis itself, which seems perfectly plausible, nor is it simply a summary of existing studies, nor is it comprehensive, although we do hope that we have achieved a reasonable balance across the contributory academic disciplines. We also do not review all technical aspects of these empirical studies, such as the extent to which they deal with econometric problems arising from omitted-variable bias, simultaneity bias, or unobserved heterogeneity in the income-health relationship. Rather, this is an interpretative essay to critically assess what can be concluded from studies to date about the effects of income inequality on health and how these effects work. If some lines of inquiry appear fruitless, it is as well to try to agree on this. If some seem especially fruitful but currently under exploited, this too is worth knowing.

We have attempted to clarify the various hypotheses that have been advanced to explain the apparently negative effect of income inequality on health at the population level. Terminology is a problem in this literature. It is not always clear whether terms that, in the social sciences have distinct meanings—such as relative income, deprivation, and social position—have been used in this literature with their precise meaning in mind or more loosely, in a sometimes interchangeable way. We may have over-interpreted the literature in what follows and erred on the side of over-classifying the literature into different hypotheses, rather than lumping all relativity theories under one heading. It turns out that, at the population level as well as—albeit to a lesser extent—at the community level, it is hard if not impossible to distinguish one variant from another.Effects of Income Inequality on Quality of Healthcare Essay

We also establish what in principle can be concluded, from studies undertaken at different levels of aggregation, about the effects of income inequality and relativities on health at the individual level. We assess the empirical literature to date, beginning with population-level studies, moving through community-level studies, and ending with individual-level studies, and then we state our conclusions.

In both England and the United States growing inequalities amid economic growth have helped to redirect attention to the issue. The election of Britain’s Blair government especially focused interest on possible remedial efforts as part of New Labour’s agenda. The Acheson report, commissioned by the secretary of state for health, made thirty-nine principal recommendations to alleviate poverty and reduce inequalities. While generally following the 1980 Black report, which was repressed by the Thatcher government, the newer report is vague in specification of underlying strategies and priorities. 4 The recommendations involve income redistribution through increased benefits and pensions, which are concrete but politically difficult, and many other programs whose costs and effectiveness are unclear.Effects of Income Inequality on Quality of Healthcare Essay

The other four volumes also abound with recommendations on reducing inequalities through policy changes in almost every sector, from child care and nutrition to employment and transportation. Beyond the moral questions concerning the persistence of poverty in an environment of plenty, such recommendations have relevance for the development of human capital for an increasingly complex global economy; for the maintenance of safe and livable communities; and for future demands on health care, social welfare, and criminal justice systems.

The U.K. National Health Service (NHS), the most strictly rationed Western health care system, and the United States, with the highest health expenditures, are both troubled by potential future health demand, as are policymakers in most other nations. They believe (probably mistakenly) that healthy populations will make fewer demands for expensive medical and other interventions, and they exhort their constituencies to practice more health-promoting behaviors. The mental leap between such conventional ideas and appreciation that different social structures produce varying health outcomes is a significant shift in paradigm. Although not a new idea, it is not one that policymakers easily embrace.Effects of Income Inequality on Quality of Healthcare Essay

“There is a social gradient in the relationship between SES and health that transcends any plausible concept of poverty, deprivation, ignorance, or powerlessness.”

The social determinants of health that typically make up this field of study are social class, sex, age, race, and ethnicity. In this essay I focus mainly on social class but note that there is a rich and growing literature indicating that social stratification has significant health effects beyond social class.

CONCEPTS OF SOCIAL CLASS
The concept of social class is intended to characterize how groupings of persons organized in hierarchical arrangements relate to one another in terms of social standing, authority, and power and influence. 5 Its more simple proxy—socioeconomic status (SES)—characterizes most empirical research, however. Typically, it is measured by education, income, occupation, and sometimes residential location. These measures are highly associated but commonly explain different components of the relationship between SES and health, suggesting that each acts through somewhat different pathways. Investigators commonly build indices that combine these effects into a single SES measure, although with powerful statistical approaches it is more reasonable to analyze components individually to assess their independent as well as their cumulative effects.Effects of Income Inequality on Quality of Healthcare Essay

Most epidemiological studies on social determinants seek to elucidate the specific pathways through which SES functions. By identifying such mediating factors as knowledge, health habits and behavior, diet and nutrition, occupational and housing hazards, control over one’s work and one’s life, social supports, coping capacities, and the like, they seek to explain the relationship and inform social interventions. The assumption is that if the pathways are completely and correctly described, the health disadvantages of those who are less privileged will be explained, and this will enable more well-designed, targeted interventions.

A different view, nicely represented in the work of Bruce Link and Jo Phelan, is that SES is a fundamental cause of health outcomes that cannot be explained simply by enumerating the various risk factors such as substance abuse or poor health practices associated with both SES and health outcomes. 6 They draw on a long tradition that derives from the classic study of suicide published in 1897 by French sociologist Emile Durkheim. 7 In his study Durkheim amassed many data to show that varying suicide rates could not be explained by individual propensities such as depression, often associated with suicide, but was more the product of the organizational relationships and belief systems of communities. Thus, Durkheim illustrated how suicide rates were higher in more highly integrated societies such as Japan, where suicide reflected norms about loyalty to the group and expiating shame, and, alternatively, in societies where norms were unclear or where religious systems encouraged greater introspection about the meaning of life.Effects of Income Inequality on Quality of Healthcare Essay

ORDER   HERE NOW

Link and his colleagues, using data on the SES link to health during various historical periods, show that while the prevalences of different risk factors have changed over time, the associations between SES and health outcomes remain and often even increase. 8 They argue that those who are more socially advantaged fare better in all historical periods, regardless of the then-prevalent risk factors, because their privileged positions provide the social arrangements, skills, information, and tools to capitalize on the most advanced knowledge and practices that facilitate health. Thus, they are first to take advantage of new protections, preventive screening opportunities, and behavior changes. Information and health opportunities eventually filter out to others, but by the time the benefits are implemented, privileged persons are using their knowledge, access, power, and financial resources to take advantage of newly emerging health opportunities.

TWO LINES OF STUDY
New vigor in studies of SES and health, and social determinants more generally, come from two lines of study that motivate the four new volumes published in 1999. The first provides increasing evidence that there is a social gradient in this important relationship between SES and health that transcends any plausible concept of poverty, deprivation, ignorance, or powerlessness. Indeed, increments of additional social advantage, even at the highest levels, in some of these studies appear to confer additional health advantage. The second comes from a variety of international comparative studies as well as national studies in several countries that suggest that inequality itself, independent of level of economic well-being, results in decrements in population health.Effects of Income Inequality on Quality of Healthcare Essay

■ THE SES HEALTH GRADIENT.
Michael Marmot and his colleagues at University College London have been involved for many years in the Whitehall Studies of British Civil Servants. 9 These ambitious studies of office-based workers at a range of civil service grades seek to explain why there continues to be a monotonic decrease in mortality and improved health with increased status. Even the lowest grades of the civil service are not poor in an absolute sense, and this population has stable employment, is relatively homogeneous, and is exposed to comparable environmental conditions. Thus, we might reasonably expect relatively little variation, particularly at the higher levels, but the gradient remains, although smaller at higher grades. Control for risk factors reduces differences but only partially explains the status gradient.

Much of the earlier work on SES and health assumed a threshold effect, in which income and education would influence disease processes up to a point until disadvantages were overcome, and then the relationship would plateau at higher levels of advantage. In developing countries, for example, modest improvements in standards of living and education bring large health gains, while in developed countries further increases in income bring only small health improvements. Many data sets showed this plateau pattern at higher SES levels, and some continue to do so. Remarkably, however, in many instances the association with socioeconomic factors extends well into the middle and upper ranges of social advantage, suggesting a more complex picture of health determinants. Complications are compounded by historical studies and comparative observations around the world that indicate that relatively economically deprived populations such as some in India, Sri Lanka, and Costa Rica have good levels of health and relatively low mortality, while other populations that are more economically advantaged do poorly. 10 In these cases, culture, education, and empowerment appear to play significant roles. Effects of Income Inequality on Quality of Healthcare Essay

■ THE INEQUALITY THESIS.
The second development in the study of SES and health is the provocative observation that independent of socioeconomic level, the amount of inequality itself in states, regions, or nations is associated with increased mortality and poorer health. This notion, first popularized in London by Richard Wilkinson, has caught the imagination of a number of researchers and policymakers. 12 The edited volume by Marmot and Wilkinson and that of Ichiro Kawachi, Bruce Kennedy, and Wilkinson bring together many of the important ideas and relevant research literature pertinent to this discussion. 13 The fact of growing income and health inequalities in the United Kingdom and the United States, despite their strong economies over the past decade, adds interest to the purported relationship.Effects of Income Inequality on Quality of Healthcare Essay

Unlike the incontestible link of SES to health, the study of the effects of inequality on health involves more difficult methodological and data problems, lack of conceptual clarity about the definition of inequality, more vagueness about possible causes, and much speculative theorizing. 14 The inequality hypothesis addresses relative differences among population aggregations and focuses on comparisons among countries or among U.S. metropolitan areas or states. Given the types of data typically used, the relationship may be artifactual in a statistical sense because of the larger effects of individual income on mortality among persons of low as compared with those of high income. 15 A recent effort to test this notion suggests that the finding is only partly attributable to this artifact, but the failure to control for other relevant factors continues to cast suspicion on the causal importance of inequality. 16

Various researchers working with individual data in multilevel analyses in contrast to ecological data, and others who have added additional controls to aggregate data to better take account of differences in income, education, time, and geographic effects, have not been able to confirm the contention of a strong inequality effect. 17 These researchers are successful in replicating the inequality effect in their initial analyses, but it disappears or is much attenuated when appropriate controls are added.Effects of Income Inequality on Quality of Healthcare Essay

The premise of this new literature is that the effects of inequality on health are real and may have even greater importance than material deprivation itself. I strongly doubt this view, but, nevertheless, many interesting studies and ideas are offered. Wilkinson presents the inequality thesis most confidently and aggressively. He speculates that “greater income inequality is one of the major influences on the proportion of the population who find themselves in situations that deny them a sense of dignity, situations that increase the insecurity they feel about their personal worth and competence and that carry connotations of inferiority in which few can feel respected, valued, and confident.” 18 The debate will continue, but the inequality effect is clearly not as large, pervasive, or consistent across outcome measures and data sets as proponents would have us believe.

Proponents often compare the United States or the United Kingdom with countries such as Japan, Norway, or Sweden, which have more equal income distributions, greater longevity, and better health. These countries, however, are more homogenous and have more of a common culture than Britain or the United States has, and it is impossible to say what is cause and what is effect.Effects of Income Inequality on Quality of Healthcare Essay

Aggregate studies of inequality cannot distinguish between per capita SES effects and inequality effects. Wilkinson argues, however, that the differences found in these studies cannot be attributed to either material living conditions or culture. Citing George Kaplan’s work on U.S. state and metropolitan area patterns of inequalities and health outcomes, Wilkinson argues that in the fifty states “cultural differences are smaller and people shop at many of the same chain stores selling the same range of goods throughout the country.” 19 Readers can decide for themselves how convinced they are by this assertion of homogeneity among states. Differing views on such issues are more than arcane arguments among scholars, because the nature of interventions and their likely success will depend on how inequality is conceived.Effects of Income Inequality on Quality of Healthcare Essay

Proponents of the inequality thesis have not always been clear about its meaning. It is one thing to have a society in which the rich become richer and the poor, poorer and quite another to have a society in which all rise in income but the more privileged rise more, increasing the income gap. Wilkinson believes, and Kawachi and Kennedy seem to concur, that growing inequalities are harmful to health even when the poor are better off, because it is a person’s relative income that affects his or her health. It is unlikely that relative deprivation, however important, has the explanatory power suggested.Effects of Income Inequality on Quality of Healthcare Essay

Wilkinson dismisses studies that do not support his thesis because the geographic units studied were too small and hence, too homogeneous. 20 He believes that one would only expect to see relative deprivation and inequality effects among larger areas with wider income heterogeneity. But if there is a lesson to be learned from the literature on relative deprivation, it is that we compare ourselves and judge equity in relationship to others like ourselves. As much as Wilkinson is offended by increases in the compensation of top U.S. executives, it has nothing to do with how most of us make judgments about ourselves. Effects of Income Inequality on Quality of Healthcare Essay