How Income Inequality affects Health in Society.

Posted on January 4, 2009 by John Karanja

The main problem with trying to ascertain whether it is low income or income distribution that results in poor health is that there are a number of confounding factors that should be investigated to determine the nature of the relationship. In fact many studies have shown that the relationship between income and health is not a linear one. That is increasingly higher incomes affects health positively but at a declining rate. This immediately suggests that there are other confounding factors for which we have to account for that play a spurious or artefactual role between income and health status of individuals within society. These factors are related not with low incomes but with the relative positions of those incomes within the population. Therefore we can suggest that the low income does not cause poor health directly but it is the spurious correlation of factors related to income inequality that result in poor health. Consequently there is a body of evidence discussed below which shows that egalitarian policies which reduce the income inequality reduce poor health and increase life expectancy in countries that implement them.

Since we know that there are cases where low income does not always mean poor health we can dismiss the extreme view that low income always causes poor health. However we can now address the income health relationship at the population level where we analyse the effect of individual incomes comparatively within the population and their relationship with health. We can also show the artefactual relationship between income distribution and health always occurs if the effect of the individual’s income on risk of mortality is higher at lower incomes (Gravelle 1998). This confirms that the study of this relationship cannot be done at the population level but must be done at the individual level to show the relationship of absolute and relative income. Cross sectional evidence shows a strong relationship between life expectancy and income distribution in contrast with the gross national product per head or mean income (Wilkinson 1992). Here he gives the example of Britain and Japan which illustrates the possible effects of income distribution and health showing that even though they both had similar income distributions and life expectancy in 1970 Japan has shown to have a higher life expectancy due more egalitarian approach to income distribution. However Britain has shown to have higher mortality rates due to higher income inequality. This enforces the point that health inequality is attributable to relative rather than absolute income. These results also show that we cannot link any association between income and health to be of direct causation but we must identify other confounding factors that lead to correlation between relative income and poor health.

Studies have attempted to discuss the problem of causation between health and income by showing that the variable and factors related to income tend to be collinear making their effect on health unclear (Rodgers 1979). He effectively states it is plausible to conclude that there is causation since there is an affect of income on mortality via intermittent variables. These factors such as inequality of health, educational and social background result in the distribution of income not the mean income comprising the function that results in changes of life expectancy. Hence it would be more correct to propose that the relationship between income distribution and poor health is a more spurious one. This point is enforced by a study done by Rodgers on significance testing which shows that the significance of income distribution is consistent across different countries because life expectancy at birth is higher by five to ten years in egalitarian societies as opposed to less egalitarian ones. He also rules out any insignificance on his study due to poor asymptote. These results confirm the position that increased income inequality does result in poor health as opposed to low income.

Sapolsky’s more recent study uses an psychological approach to show that stress as a result of income inequality does lead to poor health. This alternative argument would allow us to control individual income while assessing the impact of these external variables(i.e. stress and stress related illnesses). He analyses social rank in non human animals to form a basis in determining the effect of stress related physiology and stress related diseases to help him form an opinion on the stress factor in animals, which is then observed in human beings. This is based on the notion that human beings are fundamentally animals hence it is likely inherent human nature influences play a role in the determination of the health status of individuals. This would also explain why data stretching back centuries shows that each step down the socioeconomic ladder reduces the mental and physical health prospects of an individual (Sapolsky 2004). This is because as stress and stress related illnesses increases triggering a whole host of physical problems like increased smoking, drinking, obesity and negative lifestyles resulting in decline in health status. In addition decreased socioeconomic status leads to decrease in health protective measures like joining health clubs. All this suggests that feeling poorer than others are a result of established societal mechanisms that form social classes. These mechanisms seem to have an adverse impact on the psychological health of individuals at the lower income levels or lower social classes. Further studies have shown that poverty is not a strong predictor of crime as is poverty among plenty i.e. relative income. This relationship between psychological health and socioeconomic status shows that the effect of “perceived” low income on health exists only if it is compared at the individual level with that of other individuals within the same population. Only then can there be correlation with factors such as stress and perceived poverty which results in detrimental effects at each lower socioeconomic level. For example in the United states the higher the degree of income inequality the poorer the health. It is also critical to observe that in an egalitarian society the distribution of wealth would reduce the health status of the wealthy slightly though this effect is too small compared to the general effect of income inequality in less egalitarian societies. However so as to resolve any lingering doubt of this relation it is important using variable regression models we examine further the effect of these indicators accompanying income distribution in society.

From the discussion above we can see various studies have investigated the link between income and health and have shown there is no causation between low income and poor health. However the studies have shown clearly a spurious correlation exists between income distribution and poor health status. Results of logistic regression models (Kennedy 1998) indicate that factors such as health insurance status, smoking status, education status create a spurious relationship between income distribution and mortality. More importantly these models show that income distributions are associated with self rated or poor health even after mean individual income is accounted for, further enforcing the point that it is income distribution which should be considered when showing correlation with other factors to poor health.

In conclusion we can state that it is income distribution rather than low income that affects the health status of an individual. The relationship between income and health is clearly not a causal one because of the effect of intermittent variables that spuriously affects health status of individuals. We can simply visual a scenario where a person with a low income is able to have better health than an individual who has high income but feels that he is not doing well comparatively. The factors that surround income inequality create a much higher risk to poorer health incomes than those surrounding low incomes. This is a useful point to consider while trying to establish the factors that make some societies more egalitarian than others. It is also important for future studies to continue to investigate the psychological factors related to income distribution because they seem to catalyse other problems such as drug abuse which increases health problems for the individuals concerned. These negative outcomes of income inequality suggest it would be too simple to suggest that low incomes cause poor health.

References:

Wilkinson R. G. (1992). Income distribution and life expectancy. British Medical Journal, 304, 165-168

Gravelle, H. (1998). How much of the relation between population mortality and unequal distribution of income is a statistical artefact? British Medical Journal 316, 382-385.

Kennedy, B. Pp. Kawachi, I., and Prothrow-Stith, D. (1998). Income distribution, socioeconomic status and self rated health: a U.S. multi-Level analysis. British Medical Journal, 317, 917-921

Rodgers, G.B. (1979). Income and inequality as determinants of mortality. Population Studies, 33(2), 343-351

Deaton, A. (2003). Health inequality and economic development. Journal of Economic Literature, 41(1) 113-158.

Sapolsky, R. M. (2004). Social status and health in humans and other animals. Annual Review of Anthropology, 33, 393-418.

Of Parental Divorce and Children

Posted on December 18, 2008 by John Karanja

Parental divorce generally harms children significantly in the long term financially, psychologically, socially, physically and mentally. This due to these children lacking social capital, a term used to decribe social and emotional support systems that exist due to the existence of families within society (James Coleman). This is fundamentally because divorce involves the separation of husband and wife and break up of the family in an acrimonous manner that usually deprives the children of the benefit of a secure and stable informal learning environment. Divorce consequently reduces the ability of parents to buffer their children against negative factors in the environment. However there are some exceptional cases where divorce reduces harm to the children in the short term especially where there is abuse from either parent directed at the spouse and children. Divorce may reduce the physical and some physcological harm to the children but long term harm will still occur.

Divorce affects the children financially because of the break up of the financial structure within the familly because both parents now have to rely on their own personal incomes to survive whereas before they would usually pool their incomes into one financial resource that would usually help achieve more family goals. Biblarz and Raftery state “Since children’s success depends on the economic resources and equivalent services that parents provide, children who spend most of their childhood in a two-parent family (biological or stepfamily) will have the highest attainments because two parental figures are present to provide complementary resources.” As a result the separating couple individually would now have to use their personal incomes and effort to set up their own households hence spending less on goods benefitting the children such as quality education and better health care. Furthermore if the father were to set up another household elsewhere than these children would suffer more because the father would spend less on them and as a result they would be strained financially. Evidence shows that most fathers in the British cohort study (Kiernan 1999) do not give child support to their children because of fear how the mother would use the funds. Even in the cases where fathers do give support to their children they usually give far less than what husbands support their children with. This indicates that divorce creates a financial constraint reducing the availability of beneficial goods for children whose parents are divorced.

The social impact of divorce is enormous because study shows that children from divorced families tend to be more prone to divorce their partners later in their lives than those who come from normal households. Infact the impact on divorce in children is greater if the parents divorce in the childrens formative years, i.e between 0 and 19 years as opposed to divorce in their later years 20 to 33 years (Seltzer 1994). This is because in the formative years children need both parents to develop adequate social skills and values that will help them form stable relationships in the future. For example male children need their fathers to guide them to become responsible men. The missing father is more devastative for boys than for girls as shown in the Moynihan report (1965). Men who grow with their single parent mothers tend to behave in a deviant way possessing violent natures eventually getting involved in criminal behaviour. Divorce also harms children because as Biblarz argues that divorced mothers tend not to get social support and therefore do not enjoy socioeconomic benefits that for example widowed mothers enjoy. This suggests children from divorced families are worse off in the long term than children from widowed families. British birth cohort hazard analysis (Kiernan 1999) for ages 0 to 33 shows how children from divorced children perform socially i.e the probabilities that they will exhibit behavioural problems at any age are much higher than those from stable families which indicates that divorce has a higher social impact for children from divorced families especially if the divorce occurs during the formative years of the child i.e. ages 4 to 19.

Many children from divorced families also tend to get affected psychologically and eventually get depressed and suicidal as opposed to children in normal families. This is because first and foremost they are unable to take sides with either parent during the divorce making them feel as though the divorce is their fault. Such children usually get affected by their parents arguing and fighting and this errodes their personal confidence and sense of security. “Children of divorce have lower attainments than children from two-parent families because they have had sustained exposure to their parents’ discord”(Biblarz and Raftery 1999). When the divorce eventaully happens the children feel inadequate and may end up being emotionally distabilized should no counselling measures be taken. This leads to drug abuse in some cases and in the most extreme cases suicide. Divorce also forces couples to move apart sometimes very far from each other. Should the non custodial parent (usually the father) not communicate frequently, then the children may also feel a sense of loss of a parent. Girls are affected by the absense of their father by tending to be emotionally detached (withdrawn) from boys and men (including their husbands) later in their lives. Divorce however seems to have a larger effect on boys than on girls (Kiernan 1999), this translates in behavioural and psychological problems having larger outcomes on boys explaining why most boys in this categories exhibit more violent or criminal tendencies than boys from stable homes. Girls seem to get affected by becoming neurotic depressive, a condition that is also exacerbated by their mothers behaviour. This situation is also carried into future relationships and may explain why marriages of these children don’t seem to last.

Divorce causes long term physical and consequently mental disorders for children who are between the ages of 0 and 4 in the long term, (Kiernan 1999). This is because when divorce happens when a child is of that age it means that the child does not get the adequate care it needs to develop fully. For instance if the child is in the custody of the father it misses breastfeeding opportunities as well as post natal care that leads to mental and mental deformities later on. This makes them unable to do well in sporting activities and school activities. In this regard these children are at a great disadvantage compared to their counterparts in stable families (Duncan and Duncan 1969; McLanahan and Sandefur 1994). Also due to the strain in financial resources in single parentship, these children are aslo not enrolled in positive social groups such as football teams or piano,ballet classes hence do not develop extracurricularly. As with the case with social skills lack of additional skills means that they rarely develop into leadership roles, a characteristic they take to their marriages. This is particularly detrimental to men who are then expected to assume the leadership role in a family but are normally unable to do so because of their own upbringing.

In conclusion the long term effects of divorce on children are detrimental because they lead to many psychologically and physical disorders that make it difficult for these children to adapt social values that will help them in forming stable relationships in the future. Divorce also clearly has an effect on the financial and social well being of children who are affected by it. The full effects of divorce can be reduced by surrounding the children with an enabling environment that will pass onto them social values and required financial and emotional support that will reduce the long terms effects of divorce. I argue that step families and specialized mentorship in schools will go someway in reducing these harmful effects of divorce. However there are clearly situations where divorce does mitigate against physical, emotional abuse that children may be getting from one parent. However in this case though the divorce would be better in the short term, these children would tend to be worse of than children whose parents are non abusive because they would suffer the long term effects of the divorce as well as the abuse.

REFERENCES

Kiernan, K. and Cherlin, A. J. (1999). Parental divorce and partnership dissolution in adulthood: evidence from a British cohort study. Population Studies, 53, 39-48

Ni Brolchain, M. (2001). ‘Divorce effects’ and causality in the social sciences. European social review, 17(1), 33-57

Biblarz, T.J. and Raftery, A. E. (1999). Family structure, educational attainment, and socioeconomic success: rethinking the “pathology of matriarchy “. American Journal of Sociology, 105(2), 321-365

Seltzer, J. (1994). Consequences of marital dissolution for children. Annual Review of Sociology, 20, 235-266

Mc Lanahan S. and Sandefur, G. (1994). Growing Up with a Single Parents: What Hurts, What Helps? Harvard University Press, Cambridge, Massachusetts.

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