Country-level Income Inequality Research Articles

Socioeconomic inequalities in adolescent mental health in the Nordic countries in the 2000s - A study using cross-sectional data from the Health Behaviour in School-aged Children study

BackgroundAdolescents in Sweden experience more mental health problems and lower mental well-being than adolescents in other Nordic countries. According to the literature, one possible explanation may be differences in income inequality. The at-risk-of-poverty rate varies significantly across the Nordic countries, and the highest rate is found in Sweden. The aims of the study were to examine socioeconomic inequalities in subjective health complaints and life satisfaction among adolescents in the Nordic countries during 2002 − 2018 and to explore whether subjective health complaints and life satisfaction were related to income inequality in terms of the at-risk-of-poverty rate at the country level.MethodsData regarding 15-year-olds from the Health Behaviour in School-aged Children study from five survey rounds (2002 − 2018) were used (n = 41,148). The HBSC Symptoms Checklist and Cantril’s ladder were used as measures of subjective health complaints and life satisfaction, respectively. The Family Affluence Scale, the Perceived Family Wealth item and the at-risk-of-poverty rate in each country were used as measures of individual-level socioeconomic conditions and country-level income inequality. Statistical methods involved ANOVA, multiple linear regressions and multilevel regression analyses.ResultsAbsolute and relative socioeconomic inequalities in both subjective health complaints and life satisfaction were found in all countries. Sweden showed average socioeconomic inequalities, Iceland the largest and Denmark the smallest. Country-level income inequality in terms of the at-risk-of-poverty rate was associated with a higher prevalence of subjective health complaints and lower levels of life satisfaction in all countries.ConclusionSocioeconomic inequalities in adolescent mental health and well-being persisted in Nordic countries in the 2000s. Increasing income inequality may have contributed to higher levels of SHC and lower LS in Sweden compared to the other Nordic countries. Policies improving families’ socioeconomic conditions and reducing income inequality at the country level are needed to improve and reduce inequalities in mental health and well-being among adolescents.

Unequal perspectives? Income inequality as a benchmark for support for European integration

Despite growing attention to income inequality in debates about European integration, our understanding of its effect on European Union support remains limited. Using European Social Survey data from 2002 to 2020, we analyse how income inequality and pro-redistribution attitudes shape diffuse and specific forms of support for the European Union. We find no direct effect of country-level income inequality, while individual support for redistribution has a negative effect on both. In line with benchmarking theory, inequality emerges as a contextual moderator: in unequal national settings, egalitarian citizens are comparatively more supportive of further integration than in more equal countries. This effect persists when we control for income position, suggesting an ideological rather than utilitarian basis for benchmarking European Union attitudes. We discuss implications in light of debates about a social Europe.

A global comparative study of wealth-pain gradients: Investigating individual- and country-level associations.

Pain is a significant yet underappreciated dimension of population health. Its associations with individual- and country-level wealth are not well characterized using global data. We estimate both individual- and country-level wealth inequalities in pain in 51 countries by combining data from the World Health Organization's World Health Survey with country-level contextual data. Our research concentrates on three questions: 1) Are inequalities in pain by individual-level wealth observed in countries worldwide? 2) Does country-level wealth also relate to pain prevalence? 3) Can variations in pain reporting also be explained by country-level contextual factors, such as income inequality? Analytical steps include logistic regressions conducted for separate countries, and multilevel models with random wealth slopes and resultant predicted probabilities using a dataset that pools information across countries. Findings show individual-level wealth negatively predicts pain almost universally, but the association strength differs across countries. Country-level contextual factors do not explain away these associations. Pain is generally less prevalent in wealthier countries, but the exact nature of the association between country-level wealth and pain depends on the moderating influence of country-level income inequality, measured by the Gini index. The lower the income inequality, the more likely it is that poor countries experience the highest and rich countries the lowest prevalence of pain. In contrast, the higher the income inequality, the more nonlinear the association between country-level wealth and pain reporting such that the highest prevalence is seen in highly nonegalitarian middle-income countries. Our findings help to characterize the global distribution of pain and pain inequalities, and to identify national-level factors that shape pain inequalities.

The Relationship Between Inequality and Potential Emigration: Evidence from the Gallup World Poll

The existing literature presents conflicting findings regarding the relationship between inequality and potential emigration. This paper utilizes individual-level data from the Gallup World Poll and country-level income inequality measures for 150 countries to contribute new evidence. The findings indicate that increasing inequality is linked to decreased desires and plans for emigration, a consistent global trend observed across various inequality measures and specifications. Notably, this association is more pronounced for women, individuals without overseas networks, and those lacking financial and human capital. Additionally, the study sheds light on how the level of economic development in countries influences the relationship. In low- and middle-income countries, rising inequality is negatively associated with emigration intentions. Conversely, in affluent nations, heightened inequality stimulates greater desires to emigrate, particularly among high-income and highly educated individuals. These insights provide a deeper understanding of how inequality shapes emigration in diverse world regions and across different cohorts, bridging gaps between previous divergent findings.

Income inequality and its relationship with loneliness prevalence: A cross-sectional study among older adults in the US and 16 European countries.

The prevalence of loneliness increases among older adults, varies across countries, and is related to within-country socioeconomic, psychosocial, and health factors. The 2000-2019 pooled prevalence of loneliness among adults 60 years and older went from 5.2% in Northern Europe to 24% in Eastern Europe, while in the US was 56% in 2012. The relationship between country-level factors and loneliness, however, has been underexplored. Because income inequality shapes material conditions and relative social deprivation and has been related to loneliness in 11 European countries, we expected a relationship between income inequality and loneliness in the US and 16 European countries. We used secondary cross-sectional data for 75,891 adults age 50+ from HRS (US 2014), ELSA (England, 2014), and SHARE (15 European countries, 2013). Loneliness was measured using the R-UCLA three-item scale. We employed hierarchical logistic regressions to analyse whether income inequality (GINI coefficient) was associated with loneliness prevalence. The prevalence of loneliness was 25.32% in the US (HRS), 17.55% in England (ELSA) and ranged from 5.12% to 20.15% in European countries (SHARE). Older adults living in countries with higher income inequality were more likely to report loneliness, even after adjusting for the sociodemographic composition of the countries and their Gross Domestic Products per capita (OR: 1.52; 95% CI: 1.17-1.97). Greater country-level income inequality was associated with higher prevalence of loneliness over and above individual-level sociodemographics. The present study is the first attempt to explore income inequality as a predictor of loneliness prevalence among older adults in the US and 16 European countries. Addressing income distribution and the underlying experience of relative deprivation might be an opportunity to improve older adults' life expectancy and wellbeing by reducing loneliness prevalence.

Is the mediating effect of psychosocial stress on the income–health relationship moderated by income inequality?

BackgroundThere now exists a rich body of literature on the relationship between income, income inequality, and health. The discussion about the impact of income and income inequality on health includes psychosocial mechanisms, such as long-term perceptions of inferiority and social positioning, material advantage from income, and the structural conditions that define what people can do with their material resources. AimsThis study investigated the extent to which income's effects on health are mediated by psychosocial stress, and to what extent those effects are moderated by country-level income inequality and economic development. MethodsData were collected from The European Social Survey, round 7. Multilevel moderated mediation analysis was applied to estimate the extent of psychosocial stress mediation of the effects of income on self-rated health. Moderated parameters were estimated over country-level income inequality and economic development. ResultsSignificant full or partial meditation by psychosocial stress was found in all 20 countries studied. Effects moderated by income inequality and GDP per capita showed expected relationships but failed to reach conventional levels of statistical significance. ConclusionsIndividual-level income remains important for explaining the income–health gradient in self-rated health in Europe. The income–health relationship and the extent to which it is mediated by psychosocial stress varies among countries but is not significantly moderated by contextual income or income inequality. Policies should be aimed at allowing a greater proportion of people to live in material comfort and reduced sense of financial precarity, and protecting individuals from harmful consequences of low income.

The paradox of local inequality: Meritocratic beliefs in unequal localities.

A puzzle has emerged amidst rising inequality: why do people profess high levels of belief in meritocracy even as income gains are increasingly concentrated at the top? In light of contradictory theories and evidence, we undertake the first assessment of the relationship between local income inequality and meritocratic beliefs outside the United States, using data from the UK Household Longitudinal Study. We find that the positive relationship between country‐level income inequality and meritocratic beliefs identified in the recent literature does not translate straightforwardly below country level: there is no robust relationship between local income inequality and meritocratic beliefs in England. However, there is a robust—and somewhat paradoxical—positive association between high local income inequality and meritocratic beliefs among those with the lowest incomes. On average, respondents with annual household incomes of £10,000 are five points more likely (on a 100‐point scale) to believe their hard work will pay off if they live in the most rather than the least unequal places in England. We also show that this applies beyond the specific case of meritocratic beliefs: low‐income respondents in unequal places are also notably more satisfied with their own (low) income than similar respondents in more equal localities. In line with system justification theory, we argue that belief in meritocracy serves as an important tool of psychological resilience for low‐income individuals who regularly come into contact with others more economically fortunate than themselves: though it legitimates their current position at the bottom of the status hierarchy, this belief also offers the promise of future advancement. While this reduces concern about the psychological effects of growing local income inequality on the most economically vulnerable, it also suggests that there is little prospect of demand for systemic economic change emerging from what might have been considered the most likely places.

Income inequality and COVID-19 mortality: Age-stratified analysis of 22 OECD countries.

Our study builds on a growing body of research that demonstrates an association between income inequality and COVID-19 mortality. Using Poisson multivariate regression, we age-stratify our analysis by separately examining each of four age groups over a nine-month study period in 22 OECD countries. Our full regression model controls for national median income and relative poverty, and a set of pandemic-specific variables to capture exposure, susceptibility and treatment. We found that country-level income inequality, as measured by the disposable income Gini coefficient, is significantly and positively associated with COVID-19 mortality for all four age groups. Consistent with previous studies that analyzed all-cause mortality by age, our regression results found that the point estimate of the Gini coefficient generally declines with age. Our results suggest that inequality is possibly acting through generic and pandemic-specific processes to increase mortality via a more pronounced negative COVID-19 socio-economic status gradient in higher inequality countries.

Income Inequality, Poverty, and Fear of Crime in Europe

Studies of fear of crime in Europe associate country-level income inequality with fear of crime. However, by considering only income inequality these studies do not account for the effects of poverty. This article provides a more comprehensive perspective through multiple country-level indicators of income inequality and poverty and thereby provides important insights into fear of crime. The research data consist of the European Social Survey, Round 7 (2014), and country-level indicators provided by Eurostat. The results show that the Gini coefficient, S80/S20 ratio, and material deprivation are positively associated with fear of crime. The association is statistically significant but is moderate at best. However, the association between the relative median at-risk-of-poverty risk gap and fear of crime is not statistically significant. Education and income only appear to be mediators between material deprivation and fear of crime. Trust appears to be a mediator between the country-level indicators and fear of crime.

Burden Sharing: Income, Inequality and Willingness to Fight

What explains citizens’ willingness to fight for their country in times of war? Using six waves of the World Values Survey, this study finds that individual willingness to fight is negatively related with country-level income inequality. When income inequality is high, the rich are less willing to fight than the poor. When inequality is low, the poor and rich differ little in their willingness to fight. This change in the willingness to fight between low and high inequality countries is greater among the rich than among the poor. This article explores several explanations for these findings. The data are consistent with the argument that high inequality makes it more attractive for the rich to buy themselves out of military service.

Income inequality and adolescent fertility in low-income countries

Abstract: The well-known socioeconomic gradient in health does not imply that income inequality by itself has any effect on well-being. However, there is evidence of a positive association between income inequality and adolescent fertility across countries. Nevertheless, this key finding is not focused on low-income countries. This study applies a multilevel logistic regression of country-level adolescent fertility on country-level income inequality plus individual-level income and controls to the Demographic and Health Surveys data. A negative association between income inequality and adolescent fertility was found among low-income countries, controlling for income (OR = 0.981; 95%CI: 0.963-0.999). Different measures and different subsamples of countries show the same results. Therefore, the international association between income inequality and adolescent fertility seems more complex than previously thought.

The rich get richer and the poor get poorer: Country- and state-level income inequality moderates the job insecurity-burnout relationship.

Despite the prevalence of income inequality in today's society, research on the implications of income inequality for organizational research is scant. This study takes the first step to explore the contextual role of national- and state- level income inequality as a moderator in the relationship between individual-level job insecurity (JI) and burnout. Drawing from conservation of resource (COR) theory, we argue that income inequality at the country-level and state-level threatens one's obtainment of object (i.e., material coping) and condition (i.e., nonmaterial coping) resources, thus serving as an environmental stressor exacerbating one's burnout reactions to JI. The predicted cross-level interaction effect of income inequality was tested in 2 studies. Study 1 consisting of 23,778 individuals nested in 30 countries explored the moderating effect of country-level income inequality on the relationship between individual JI and exhaustion. Study 2 collected data from 402 employees residing in 48 states in the United States, and tested the moderating effect of state-level income inequality on the relationship between JI and burnout (i.e., emotional exhaustion and cynicism). Results of both studies converge to support the exacerbating role of higher-level income inequality on the JI -burnout relationship. Our findings contribute to the literature on psychological health disparities by exploring the contextual role of income inequality as a predictor of differential reactions to JI. (PsycINFO Database Record

Economic Inequality and Social Entrepreneurship

This article explores the extent to which income inequality and income mobility—both considered indicators of economic inequality and conditions of formal regulatory institutions (government activism)—facilitate or constrain the emergence of social entrepreneurship. Using 77,983 individual-level responses obtained from the Global Entrepreneurship Monitor (GEM) survey of 26 countries, and supplementing with country-level data obtained from the Global Competitiveness Report of the World Economic Forum, our results from multilevel analyses demonstrate that country-level income inequality increases the likelihood of individual-level engagement in social entrepreneurship, while income mobility decreases this likelihood. Further, income mobility negatively moderates the influence of income inequality on social entrepreneurship, such that the condition of low income mobility and high income inequality is a stronger predictor of social entrepreneurship. We discuss implications and limitations of our study, and we suggest avenues for future research.

Income inequality and Neisseria gonorrhoeae notifications in females: a country-level analysis

Background Patterns of population susceptibility to sexually transmissible infections may be influenced by various social determinants of health, however these receive relatively little attention. Income inequality is one such determinant that has been linked to a number of poor health outcomes. The objective of this analysis was to determine whether there is an association between income inequality and Neisseria gonorrhoeae notification rates when measured at the country level. Gini coefficients, gonorrhoea notification rates among women, per capita gross domestic product and approximate size of female population were obtained for 11 countries of the OECD. Linear regression was used to measure the association between income inequality and gonorrhoea notification rates, using generalised estimation equations (GEE) to control for the non-independence of repeat measures from particular countries. A total of 36 observations from 11 countries were included. Gini coefficients ranged from 0.21 to 0.38 and gonorrhoea notifications from 0.7 to 153 per 100000 females. Significant associations were found between country-level income inequality and gonorrhoea notification rates among women (b=17.79 (95% CI: 10.64, 24.94, P<0.01). Significant associations were found, highlighting the importance of acknowledging and accounting for social determinants of sexual health and suggesting that further research in this arena may be fruitful.

Country- and individual-level socioeconomic determinants of depression: multilevel cross-national comparison

The prevalence and correlates of depression vary across countries. Contextual factors such as country-level income or income inequalities have been hypothesised to contribute to these differences. To investigate associations of depression with socioeconomic factors at the country level (income inequality, gross national income) and individual (education, employment, assets and spending) level, and to investigate their relative contribution in explaining the cross-national variation in the prevalence of depression. Multilevel study using interview data of 187 496 individuals from 53 countries participating in the World Health Organization World Health Surveys. Depression prevalence varied between 0.4 and 15.7% across countries. Individual-level factors were responsible for 86.5% of this variance but there was also reasonable variation at the country level (13.5%), which appeared to increase with decreasing economic development of countries. Gross national income or country-level income inequality had no association with depression. At the individual level, fewer material assets, lower education, female gender, economic inactivity and being divorced or widowed were associated with increased odds of depression. Greater household spending, unlike material assets, was associated with increasing odds of depression (adjusted analysis). The variance of depression prevalence attributable to country-level factors seemed to increase with decreasing economic development of countries. However, country-level income inequality or gross national income explained little of this variation, and individual-level factors appeared more important than contextual factors as determinants of depression. The divergent relationship of assets and spending with depression emphasise that different socioeconomic measures are not interchangeable in their associations with depression.

Housing, income inequality and child injury mortality in Europe: a cross‐sectional study

Child poverty rates are compared throughout Europe to monitor how countries are caring for their children. Child poverty reduction measures need to consider the importance of safe living environments for all children. In this study we investigate how European country-level economic disparity and housing conditions relate to one another, and whether they differentially correlate with child injury mortality. We used an ecological, cross-sectional study design of 26 European countries of which 20 high-income and 6 upper-middle-income. Compositional characteristics of the home and its surroundings were extracted from the 2006 European Union Income Social Inclusion and Living Conditions Database (n = 203,000). Mortality data of children aged 1-14 years were derived from the World Health Organization Mortality Database. The main outcome measure was age standardized cause-specific injury mortality rates analysed by income inequality and housing and neighbourhood conditions. Nine measures of housing and neighbourhood conditions highly differentiating European households at country level were clustered into three dimensions, labelled respectively housing, neighbourhood and economic household strain. Income inequality significantly and positively correlated with housing strain (r = 0.62, P = 0.001) and household economic strain (r = 0.42, P = 0.009) but not significantly with neighbourhood strain (r = 0.34, P = 0.087). Child injury mortality rates correlated strongly with both country-level income inequality and housing strain, with very small age-specific differences. In the European context housing, neighbourhood and household economic strains worsened with increasing levels of income inequality. Child injury mortality rates are strongly and positively associated with both income inequality and housing strain, suggesting that housing material conditions could play a role in the association between income inequality and child health.

Cross-National Comparisons of Time Trends in Overweight Inequality by Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys From 37 Developing Countries, 1989–2007

Chronic diseases are now among the leading causes of morbidity and mortality in lower income countries. Although traditionally related to higher individual socioeconomic status (SES) in these contexts, the associations between SES and chronic disease may be actively changing. Furthermore, country-level contextual factors, such as economic development and income inequality, may influence the distribution of chronic disease by SES as well as how this distribution has changed over time. Using overweight status as a health indicator, the authors studied repeated cross-sectional data from women aged 18-49 years in 37 developing countries to assess within-country trends in overweight inequalities by SES between 1989 and 2007 (n=405,550). Meta-regression was used to examine the associations between gross domestic product and disproportionate increases in overweight prevalence by SES, with additional testing for modification by country-level income inequality. In 27 of 37 countries, higher SES (vs. lower) was associated with higher gains in overweight prevalence; in the remaining 10 countries, lower SES (vs. higher) was associated with higher gains in overweight prevalence. Gross domestic product was positively related to faster increase in overweight prevalence among the lower wealth groups. Among countries with a higher gross domestic product, lower income inequality was associated with faster overweight growth among the poor.

Do Economic Inequalities Harm Health? Evidence from Europe

Until recently, there has been a consensus among empirical health economists that there is an association between income inequality and individual health, in line with Wilkinson's (1992) idea that the psychosocial effects of the former are detrimental to the latter. However, using US data, Mellor and Milyo (2002) (MM) found no evidence of such association and claimed that the previously reported results are statistical artifacts, arising from the use of aggregate data. This paper uses the European Community Household Panel (ECHP) to check the robustness of MM results. It replicates the MM methodology to assess the effect of country-level income inequality on individuals' health. It is shown that income inequality, whether measured at the regional or the national level, systematically harms individuals' health, regardless of their positions in the income distribution. The results are also robust to a number of aspects MM do not account for. First, random effect models are estimated to account for unobserved heterogeneity. Second, self-assessed and objective measures of health status are also considered. Third, besides the traditional aggregate measures of income inequality, a further measure is constructed reflecting first, how unequal the distribution is and second the relative position of individuals in the income distribution of their own country.