Psychosocial and material pathways in the relation between income and health: a response to Lynch et al

Abstract

Much of the debate on health inequalities has centred on the damage done by poverty. However, evidence suggests that health is also related to inequality. Firstly, as the Whitehall studies of British civil servants show, there is a gradient in health among those who are not poor, indicating that the higher the socioeconomic position, the lower the morbidity and mortality.1–4 Whole population samples show that this gradient runs right across societies and that its magnitude varies between societies and over time. 5 6 Although absolute mortality has been falling in Britain, inequalities in mortality have increased. 7 8 Secondly, despite the health gradient within societies, there is little relation between average income (gross domestic product per capita) and life expectancy in rich countries. This suggests that absolute material standards are not, in themselves, the key. Thirdly, there is a strong relation between mortality and income inequalities. People living in countries with greater income inequality have a shorter life expectancy.9–11 Furthermore, a similar relation has been found for geographical areas within countries.12–15 #### Summary points Economic and social circumstances affect health through the physiological effects of their emotional and social meanings and the direct effects of material circumstances Material conditions do not adequately explain health inequalities in rich countries The relation between smaller inequalities in income and better population health reflects increased psychosocial wellbeing In rich countries wellbeing is more closely related to relative income than absolute income Social dominance, inequality, autonomy, and the quality of social relations have an impact on psychosocial wellbeing and are among the most powerful explanations for the pattern of population health in rich countries These observations support our argument that there are psychosocial pathways associated with relative disadvantage which act in addition to the direct effects of absolute material …