Income, Poverty, and Health Inequality | Health Disparities | JAMA Forum Archive | JAMA Network
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Income, Poverty, and Health Inequality

The health of people with low incomes historically has been a driver of public health advances in the United States. For example, in New York City, cholera deaths during outbreaks in 1832 and 1854 concentrated among the poor helped push forward the Metropolitan Health Law, which allowed for regulation of sanitary conditions in the city. The law was an exemplar for other municipalities across the United States, saving countless lives during subsequent cholera epidemics as well as from typhus, dysentery, and smallpox.

Health inequality persists today, though our public health response—our modern Metropolitan Health Laws—must address more insidious causes and conditions of illness. There is a robust literature linking income inequality to health disparities—and thus widening income inequality is cause for concern. US Census data show a steady increase in summary measures of income inequality over the past 50 years. The association between income and life expectancy, already well established, was detailed in a landmark 2016 JAMA study by Raj Chetty, PhD, of Stanford University, and colleagues. This study found a gap in life expectancy of about 15 years for men and 10 years for women when comparing the most affluent 1% of individuals with the poorest 1%. To put this into perspective, the 10-year life expectancy difference for women is equal to the decrement in longevity from a lifetime of smoking.

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