Income inequality and health: What have we learned so far?
Income inequality and health: What have we learned so far?
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DOI：
10.1093/epirev/mxh003
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发表时间：
2004-01-01
影响因子：
5.5
通讯作者：
Kawachi, I
中科院分区：
文献类型：
--
作者：
Subramanian, SV;Kawachi, I
在过去的三十年里，许多发达国家都经历了收入不平等的急剧上升，美国也不例外。例如，美国的平均年薪在1998年通货膨胀调整后从1970年的32，522美元增加到1999年的35，864美元，也就是说，在30年中只增加了10%。相比之下，在同一时期，前100名首席执行官的平均年薪从130万美元（或普通工人工资的39倍）上升到3750万美元（或普通工人工资的1,000多倍）。最近财富不平等的趋势同样值得注意。前10%家庭的净资产从1998年的493 400美元增加到2001年的833 600美元，增长了69%。相比之下，同期收入最低的五分之一家庭的净资产增长了24%，达到7900美元。在20世纪90年代的大部分时间里，收入最高的10%家庭的平均累积财富是中低收入家庭的12倍，但在2001年，收入最高的家庭的平均净资产大约是中低收入家庭的22倍（3）。现在人们普遍认为收入贫困是过早死亡和发病率增加的风险因素（4）。还应该指出的是，有令人信服的证据表明，从健康状况不佳到持续贫困和经济增长放缓的反向路径。然而，在这篇评论中，我们关注的问题是：一个社会中收入的不平等分配是否会对生活在这个社会中的个人的健康造成额外的危害？早期的生态学研究，在其他地方总结（6，7），提出了收入不平等和健康状况差之间的关联。然而，这些研究受到了批评，因为它们无法将个人收入（和收入贫困）的影响与收入不平等的背景影响分开。换句话说，收入不平等（例如，
Many developed countries have experienced a sharp rise in income inequality during the past three decades, and the United States is no exception (1). For example, the average annual salary in America in inflation-adjusted 1998 dollars increased from $32,522 in 1970 to $35,864 in 1999, that is, a modest 10 percent increase over three decades. By contrast over the same period, the average annual compensation of the top 100 chief executive officers rose from $1.3 million (or 39 times the pay of an average worker) to $37.5 million (or more than 1,000 times the pay of an average worker)(2). Recent trends in wealth inequality have been equally noteworthy. The net worth of families in the top decile rose by 69 percent, to $833,600 in 2001, from $493,400 in 1998. By contrast over the same period, the net worth of families in the lowest fifth of income earners rose 24 percent, to $7,900. The median accumulated wealth of families in the top 10 percent of the income distribution was 12 times that of lower-middle-income families through much of the 1990s, but in 2001, the median net worth of the top earners was about 22 times as great (3).It is by now widely accepted that income poverty is a risk factor for premature mortality and increased morbidity (4). It should also be noted that there exists persuasive evidence indicating the reverse pathway, from poor health status to persistent poverty and poorer economic growth (5). In this review, however, we focus on the question: Does the unequal distribution of income in a society pose an additional hazard to the health of the individuals living in that society? Earlier ecologic studies, summarized elsewhere (6, 7), suggested an association between income inequality and poor health status. However, these studies have been criticized because of their inability to disentangle the effects of individual income (and income poverty) from the contextual effects of income inequality (6). In other words, an ecologic association between income inequality (eg, measured by