How do perceived changes in inequality affect health?

Alexi Gugushvili,Aaron Reeves,Ewa Jarosz

doi:10.1016/j.healthplace.2019.102276

Abstract

Individuals do not possess an entirely accurate assessment of the level of income differences in their society and so changes in quantitative measures of income inequality may not always align with changes in the perceptions of income inequality. This disconnect is partly driven by how people form their opinions about the level of inequality. In this study we explore whether there is an association between perceptions of inequality and health, and if so, how it differs depending on the specific channel through which people formed their opinions about changes in income inequality. Drawing on data from 31 European and Eurasian countries, we find that both men and women are more likely to report bad health when their perceptions of increasing inequality are formed through experiences of inequality in their communities than through media and other channels.

Highlights

Places with higher income inequality tend to have poorer health (Hill and Jorgenson, 2018; Pickett and Wilkinson, 2015; Subramanian and Kawachi, 2006; Truesdale and Jencks, 2016; Wilkinson and Pickett, 2009)
Would we expect health to get worse if people underestimated the true level in come inequality (Hauser and Norton, 2017)? There is, a crucial distinction between income inequality as it is measured in sta tistics like the Gini coefficient
We differentiate – among individuals who declared that the gap between rich and poor increased in the past four years – between individuals who formed this belief about this increase through everyday experience and those who formed their beliefs about inequality through national media sources. We focus on those who believed inequality increased because very few people in bad health declared that inequality had fallen in the last four years (88 men and 129 women across 31 countries) and so we were unable to differ entiate between two main channels of perception formation within this group

Summary

Introduction

Places with higher income inequality tend to have poorer health (Hill and Jorgenson, 2018; Pickett and Wilkinson, 2015; Subramanian and Kawachi, 2006; Truesdale and Jencks, 2016; Wilkinson and Pickett, 2009). Part of the explanation for these cross-national differences is that highly unequal environments tend to have a greater number of materially deprived individuals, and poverty negatively affects health. Inequality may affect health through psycho-social mechanisms too (Elstad, 1998). The theory behind this mechanism is that “larger income differences increase social distances” between socio-economic groups (Pickett and Wilkinson, 2015, p.323) and this will negatively affect health because larger social distances erode social trust and lead people to feel their lives are somehow less valuable. Individual-level perceptions of macro-level inequality get under the skin through these psycho-social mechanisms, creating what Michael Marmot called “The Status Syndrome” (Marmot, 2004). Would we expect health to get worse if people underestimated the true level in come inequality (Hauser and Norton, 2017)? There is, a crucial distinction between income inequality as it is measured in sta tistics like the Gini coefficient

Methods

Results

Discussion

Conclusion