New Perspectives: "The Health Gap"

The Whitehall Study of British civil servants showed that there is a negative association between a person's position in organizational hierarchy and the incidence of chronic disease and unhealthy lifestyle choices. 

What made this study significant is that it was commonly believed that executive jobs led to worse health outcomes because of the associated stress. This is the kind of conventional wisdom that hinders effective public health interventions. 

In “The Health Gap,” Michael Marmot argues that health outcomes are influenced by stressful life events and that they are more likely to happen to people on the lower end of the socioeconomic spectrum. 

Marmot also argues this relationship means a person’s position on the socioeconomic ladder affects their level of deprivation, which influences their health outcomes relative to the general population. 

Deprivation in a general sense means lack of access to quality education, gainful employment, adequate living conditions, good nutrition and a host of other protective factors. The absence of these things leads to poorer health outcomes. 

Poverty is another issue that comes up when discussing deprivation because it is influenced by one's level of poverty. All things being equal, people with higher income will have lower rates of deprivation than those with lower income, which has devastating consequences on a key health measure: life expectancy. 

Life expectancy is the average amount of years a person is expected to live, and studies have shown that life expectancy varies across income levels. Using data between 1999 and 2014, a study showed that the difference in life expectancy between the top 1% and bottom 1% of earners is 14.6 years for men and 10.1 years for women. 

Additionally, the gap in income equality and life expectancy has increased simultaneously Between 2000 and 2014, the only households that experienced gains were high-income households. Their median income increased by about $4000, while middle-class households' median income stayed stagnant and low-class households' median income fell.

Marmot shows how deprivation from birth causes a domino effect on other aspects of life that hinder the ability of children from lower socioeconomic backgrounds to have high educational attainment, work in high income jobs and live longer lives. 

Early life stress such as physical abuse, family instability and unsafe neighborhoods causes cognitive development delays in children and poor health outcomes in life. Studies show that the children that are the most likely to grow up in these types of environments are children on the lower end of the socioeconomic spectrum. 

Growing up in unstable environments has negative effects on educational achievement. Children that grow up in challenging environments have lower rates of school readiness. They are likely to score lower on measures of vocabulary and communication skills, knowledge of numbers, copying and symbol use, ability to concentrate and cooperative play with other children than children from higher-income households.

These disadvantages accrue over a lifetime because children who suffer from childhood cognitive delays are more likely to need special education, repeat grades or drop out of high school. This, in turn, affects their future earnings because the higher the education level, the more income they are likely to make.

However, if lower-income children are more likely to drop out of high school, then it means that they are less likely than their peers from higher socioeconomic backgrounds to earn high incomes and reduce their levels of deprivation. 

What this cycle illustrates is that being born into a high-income family allows children to compound benefits that allow them to make higher incomes and enjoy better health outcomes throughout their lives relative to their peers. This pattern is more worrying given that upward social mobility in the U.S. i.e, the ability for children to outperform their parents financially has been falling since the 1940s. 

It is important to note that despite historically low poverty rates across all racial demographics in the U.S., Black and Hispanic populations are overrepresented in populations in poverty relative to the general population. This means that while other racial demographics experience poverty and deprivation, these cycles are going to be more frequent in Black and Brown populations. 

Additionally, Marmot shows that poverty is not a consequence of people not working. Barring The Great Recession and the COVID-19 pandemic, the U.S. has been at or close to its natural rate of unemployment for the majority of the 21st century. This illustrates that poverty is likely due to income inequality and other social factors, rather than people's unwillingness to work.

Despite this bleak outlook, Marmot found evidence that supports the belief that childhood poverty does not necessarily determine one's life outcome. Studies show that countries that spend a greater portion of their GDP on social programs that alleviate poverty have lower child poverty rates than countries that do not. The gap in educational attainment will narrow between people of all socioeconomic levels. For example, Finland has one of the most robust social programs in the world and consequently has better educational attainment statistics than similar countries.

He also identifies programs that could help alleviate poverty in the United States. Using conditional cash, which is subsidizing costs for families based on meeting certain criteria, transfers has been largely successful in other parts of the world and the same holds for the U.S. Conditional cash transfers in New York of about $8,700 over three years reduced material hardship and families living in poverty by 11%. It also increased the likelihood of graduating from high school. 

Conditional cash transfer programs have also been more successful than unconditional cash transfer programs implemented in countries such as Ecuador. Marmot’s aim when talking about this was to show that contrary to economists and policymakers who advocate for limited government functions, a country with strong social programs is better for health and economic outcomes. 

In “The Health Gap”, Marmot argues that health inequality is strongly linked with socioeconomic inequality and walks us through cycles of deprivation and poverty that are reinforced by ever-growing inequality. I believe that understanding this cycle is important because it shows how the structure we live in also shape us. Learning how this relationship works will spur people to recognize the importance of social reform in guaranteeing a safe and healthy society for everyone.

Contact multimedia editor Abdulghaffah Abiru at ghaffah.abiru@richmond.edu.