April 26, 2016

On Death and MoneyHistory, Facts, and Explanations

Author Affiliations
  • 1Princeton University, Princeton, New Jersey

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(16):1703-1705. doi:10.1001/jama.2016.4072

The finding that income predicts mortality has a long history. Nineteenth-century studies include Villermé1 on Paris, France, in 1817, Engels2 on Manchester, England, in 1850, and Virchow3 on Upper Silesia in 1847 through 1848. Modern analyses include the Whitehall study of British civil servants, whose status was measured by income,4 as well as similar findings for other European countries.5 Indeed, the mortality gradient by income is found wherever and whenever it is sought. Virchow’s statement3,6 that “medicine is a social science, and politics is nothing but medicine at a larger scale” has lost none of its resonance. By contrast, the medical mainstream, looking back to Koch rather than Virchow, emphasizes biology, genetic factors, specific diseases, individual behavior, health care, and health insurance.

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