This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Macinko, J. A. Articles by Wulu, J. T. Search for Related Content PubMed PubMed Citation Articles by Macinko, J. A. Articles by Wulu, J. T., Jr. Social Bookmarking                         What's this?

Income Inequality and Health: A Critical Review of the Literature

New York University Steinhardt School of Education

Leiyu Shi

Johns Hopkins Bloomberg School of Public Health

Barbara Starfield

Johns Hopkins Medical Institutions

John T. Wulu, Jr.

Bureau of Primary Health Care, HRSA/DHHS

This article critically reviews published literature on the relationship between income inequality and health outcomes. Studies are systematically assessed in terms of design, data quality, measures, health outcomes, and covariates analyzed. At least 33 studies indicate a significant association between income inequality and health outcomes, while at least 12 studies do not find such an association. Inconsistencies include the following: (1) the model of health determinants is different in nearly every study, (2) income inequality measures and data are inconsistent, (3) studies are performed on different combinations of countries and/or states, (4) the time period in which studies are conducted is not consistent, and (5) health outcome measures differ. The relationship between income inequality and health is unclear. Future studies will require a more comprehensive model of health production that includes health system covariates, sufficient sample size, and adjustment for inconsistencies in income inequality data.

Key Words: income inequality • health determinants • social epidemiology • health inequalities

Medical Care Research and Review, Vol. 60, No. 4, 407-452 (2003)
DOI: 10.1177/1077558703257169


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				V. Vargas and S. Poblete Health Prioritization: The Case Of Chile Health Aff., May 1, 2008; 27(3): 782 - 792. [Abstract] [Full Text] [PDF]

				J. E. DeVoe, A. Baez, H. Angier, L. Krois, C. Edlund, and P. A. Carney Insurance + Access != Health Care: Typology of Barriers to Health Care Access for Low-Income Families Ann. Fam. Med, November 1, 2007; 5(6): 511 - 518. [Abstract] [Full Text] [PDF]

				J. I. Elstad, E. Dahl, and D. Hofoss Associations between relative income and mortality in Norway: a register-based study Eur J Public Health, December 1, 2006; 16(6): 640 - 644. [Abstract] [Full Text] [PDF]

				B. Starfield State of the Art in Research on Equity in Health Journal of Health Politics Policy and Law, February 1, 2006; 31(1): 11 - 32. [Abstract] [PDF]

				J. R Dunn, B. Burgess, and N. A Ross Income distribution, public services expenditures, and all cause mortality in US states J Epidemiol Community Health, September 1, 2005; 59(9): 768 - 774. [Abstract] [Full Text] [PDF]

				M. Huynh, J. D Parker, S. Harper, E. Pamuk, and K. C Schoendorf Contextual effect of income inequality on birth outcomes Int. J. Epidemiol., August 1, 2005; 34(4): 888 - 895. [Abstract] [Full Text] [PDF]

				B. Starfield U.S. Child Health: What's Amiss, And What Should Be Done About It? Health Aff., September 1, 2004; 23(5): 165 - 170. [Abstract] [Full Text] [PDF]