To the Editor: The Commentary by Dr Woolf1 considers possible future health consequences of the current decline in US household income. However,
declining incomes among the middle class and increasing income inequality might not, in and of themselves, have future health consequences.
Income inequalities may instead be symptoms of broader social problems that are in turn responsible for poor health outcomes. For example, the association between income inequality and health in cross-national studies disappears when controlling for educational attainment.2 This suggests that problems with schools,
not income inequality, may drive the association.
Muennig P. Health Consequences of Declining Incomes. JAMA. 2008;299(6):633-634. doi:10.1001/jama.299.6.633-b