IDEAS home Printed from https://ideas.repec.org/p/pri/cheawb/11.html
   My bibliography  Save this paper

Health, inequality, and economic development

Author

Listed:
  • Angus Deaton

    (Princeton University)

Abstract

I explore the connection between health and inequality in both poor and rich countries. My primary focus is on the relationship between income inequality and mortality, but I also discuss the effects of inequalities in other, often more important, dimensions. I discuss a range of mechanisms, including nonlinear income effects, credit restrictions, nutritional traps, public goods provision, and relative deprivation. I review the evidence on the effects of income inequality on the rate of decline of mortality over time, on geographical pattens of mortality, and on individual-level mortality. Much of the literature, both theoretical and empirical, needs to be treated skeptically, if only because of the low quality of much of the data on income inequality. Although there are many remaining puzzles, I conclude that there is no direct link from income inequality to mortality; individuals are no more likely to die or to report that they are in poor health if they live in places with a more unequal distribution of income. The raw correlations that are sometimes found are likely the result of factors other than income inequality, some of which are intimately linked to broader notions of inequality and unfairness. That income inequality itself is not a health risk does not deny the importance for health of other inequalities, nor of the social environment. Whether income redistribution can improve population health does not depend on the existence of a direct link between income inequality and health and remains an open question.

Suggested Citation

  • Angus Deaton, 2002. "Health, inequality, and economic development," Working Papers 270, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  • Handle: RePEc:pri:cheawb:11
    as

    Download full text from publisher

    File URL: https://drive.google.com/a/princeton.edu/file/d/0BwjFN4HbBrDBWHNzbzR2dGs2N0U/view
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. John Strauss & Duncan Thomas, 1998. "Health, Nutrition, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 36(2), pages 766-817, June.
    2. Anne Case, 2004. "Does Money Protect Health Status? Evidence from South African Pensions," NBER Chapters, in: Perspectives on the Economics of Aging, pages 287-312, National Bureau of Economic Research, Inc.
    3. Arthur J. Robson, 2002. "Evolution and Human Nature," Journal of Economic Perspectives, American Economic Association, vol. 16(2), pages 89-106, Spring.
    4. repec:pri:cheawb:case_money_protect_nber.pdf is not listed on IDEAS
    5. Dasgupta, Partha & Ray, Debraj, 1987. "Inequality as a Determinant of Malnutrition and Unemployment: Policy," Economic Journal, Royal Economic Society, vol. 97(385), pages 177-188, March.
    6. Deininger, Klaus & Squire, Lyn, 1996. "A New Data Set Measuring Income Inequality," The World Bank Economic Review, World Bank, vol. 10(3), pages 565-591, September.
    7. Robert J. Waldmann, 1992. "Income Distribution and Infant Mortality," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 107(4), pages 1283-1302.
    8. Richard Auster & Irving Leveson & Deborah Sarachek, 1969. "The Production of Health, an Exploratory Study," Journal of Human Resources, University of Wisconsin Press, vol. 4(4), pages 411-436.
    9. Gary S. Becker, 1974. "Crime and Punishment: An Economic Approach," NBER Chapters, in: Essays in the Economics of Crime and Punishment, pages 1-54, National Bureau of Economic Research, Inc.
    10. Alberto Alesina & Reza Baqir & William Easterly, 1999. "Public Goods and Ethnic Divisions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 114(4), pages 1243-1284.
    11. Gottschalk, Peter & Smeeding, Timothy M., 2000. "Empirical evidence on income inequality in industrialized countries," Handbook of Income Distribution, in: A.B. Atkinson & F. Bourguignon (ed.), Handbook of Income Distribution, edition 1, volume 1, chapter 5, pages 261-307, Elsevier.
    12. Ernst Fehr & Klaus M. Schmidt, 1999. "A Theory of Fairness, Competition, and Cooperation," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 114(3), pages 817-868.
    13. Dasgupta, Partha & Ray, Debraj, 1986. "Inequality as a Determinant of Malnutrition and Unemployment: Theory," Economic Journal, Royal Economic Society, vol. 96(384), pages 1011-1034, December.
    14. James P. Smith, 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 145-166, Spring.
    15. Deaton, Angus & Lubotsky, Darren, 2003. "Mortality, inequality and race in American cities and states," Social Science & Medicine, Elsevier, vol. 56(6), pages 1139-1153, March.
    16. Jeffrey D. Sachs, 2001. "Tropical Underdevelopment," NBER Working Papers 8119, National Bureau of Economic Research, Inc.
    17. Joseph P. Newhouse & Lindy J. Friedlander, 1980. "The Relationship between Medical Resources and Measures of Health: Some Additional Evidence," Journal of Human Resources, University of Wisconsin Press, vol. 15(2), pages 200-218.
    18. Deininger, Klaus & Squire, Lyn, 1996. "A New Data Set Measuring Income Inequality," The World Bank Economic Review, World Bank, vol. 10(3), pages 565-591, September.
    19. Raghabendra Chattopadhyay & Esther Duflo, 2001. "Women as Policy Makers: Evidence from a India-Wide Randomized Policy Experiment," NBER Working Papers 8615, National Bureau of Economic Research, Inc.
    20. Bidani, Benu & Ravallion, Martin, 1997. "Decomposing social indicators using distributional data," Journal of Econometrics, Elsevier, vol. 77(1), pages 125-139, March.
    21. Benzeval, Michaela & Judge, Ken, 2001. "Income and health: the time dimension," Social Science & Medicine, Elsevier, vol. 52(9), pages 1371-1390, May.
    22. Norman Loayza & Pablo Fajnzylber & Daniel Lederman, 2000. "Crime and Victimization: An Economic Perspective," Economía Journal, The Latin American and Caribbean Economic Association - LACEA, vol. 0(Fall 2000), pages 219-302, August.
    23. Deon Filmer & Lant Pritchett, 1999. "The Effect of Household Wealth on Educational Attainment: Evidence from 35 Countries," Population and Development Review, The Population Council, Inc., vol. 25(1), pages 85-120, March.
    24. Filmer, Deon & Pritchett, Lant, 1999. "The impact of public spending on health: does money matter?," Social Science & Medicine, Elsevier, vol. 49(10), pages 1309-1323, November.
    25. Roland Bénabou, 1996. "Inequality and Growth," NBER Chapters, in: NBER Macroeconomics Annual 1996, Volume 11, pages 11-92, National Bureau of Economic Research, Inc.
    26. Atkinson, A.B. & Brandolini, A., 2000. "Promise and Pitfalls in the Use of 'Secondary' Data -Sets: Income Inequality in OECD Countries," Papers 379, Banca Italia - Servizio di Studi.
    27. Roberts, Kevin W. S., 1977. "Voting over income tax schedules," Journal of Public Economics, Elsevier, vol. 8(3), pages 329-340, December.
    28. Fogel, Robert W, 1994. "Economic Growth, Population Theory, and Physiology: The Bearing of Long-Term Processes on the Making of Economic Policy," American Economic Review, American Economic Association, vol. 84(3), pages 369-395, June.
    29. Atkinson, Anthony B., 1970. "On the measurement of inequality," Journal of Economic Theory, Elsevier, vol. 2(3), pages 244-263, September.
    30. Kaplan, G.A. & Lynch, J.W., 2001. "Is economic policy health policy?," American Journal of Public Health, American Public Health Association, vol. 91(3), pages 351-353.
    31. repec:pri:cheawb:case_money_protect_nber is not listed on IDEAS
    32. repec:fth:prinin:310 is not listed on IDEAS
    33. Macintyre, Sally, 1997. "The black report and beyond what are the issues?," Social Science & Medicine, Elsevier, vol. 44(6), pages 723-745, March.
    34. Card, David & Krueger, Alan B, 1993. "Trends in Relative Black-White Earnings Revisited," American Economic Review, American Economic Association, vol. 83(2), pages 85-91, May.
    35. Soobader, Mah-Jabeen & LeClere, Felicia B., 1999. "Aggregation and the measurement of income inequality: effects on morbidity," Social Science & Medicine, Elsevier, vol. 48(6), pages 733-744, March.
    36. Victor R. Fuchs & Mark B. McClellan & Jonathan S. Skinner, 2004. "Area Differences in Utilization of Medical Care and Mortality among US Elderly," NBER Chapters, in: Perspectives on the Economics of Aging, pages 367-414, National Bureau of Economic Research, Inc.
    37. Claudia Goldin & Lawrence F. Katz, 1999. "The Returns to Skill in the United States across the Twentieth Century," NBER Working Papers 7126, National Bureau of Economic Research, Inc.
    38. Paul Gertler & Jonathan Gruber, 2002. "Insuring Consumption Against Illness," American Economic Review, American Economic Association, vol. 92(1), pages 51-70, March.
    39. Bertola, Giuseppe, 2000. "Macroeconomics of distribution and growth," Handbook of Income Distribution, in: A.B. Atkinson & F. Bourguignon (ed.), Handbook of Income Distribution, edition 1, volume 1, chapter 9, pages 477-540, Elsevier.
    40. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    41. repec:max:cprpbr:007 is not listed on IDEAS
    42. Easterlin, Richard A., 1974. "Does Economic Growth Improve the Human Lot? Some Empirical Evidence," MPRA Paper 111773, University Library of Munich, Germany.
    43. Bardhan, Pranab & Bowles, Samuel & Gintis, Herbert, 2000. "Wealth inequality, wealth constraints and economic performance," Handbook of Income Distribution, in: A.B. Atkinson & F. Bourguignon (ed.), Handbook of Income Distribution, edition 1, volume 1, chapter 10, pages 541-603, Elsevier.
    44. Oded Galor & Omer Moav, 2004. "From Physical to Human Capital Accumulation: Inequality and the Process of Development," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 71(4), pages 1001-1026.
    45. Gravelle, Hugh & Wildman, John & Sutton, Matthew, 2002. "Income, income inequality and health: what can we learn from aggregate data?," Social Science & Medicine, Elsevier, vol. 54(4), pages 577-589, February.
    46. Lindert, Peter H., 2000. "Three centuries of inequality in Britain and America," Handbook of Income Distribution, in: A.B. Atkinson & F. Bourguignon (ed.), Handbook of Income Distribution, edition 1, volume 1, chapter 3, pages 167-216, Elsevier.
    47. Gabriele Doblhammer, 2002. "Differences in lifespan by month of birth for the United States: the impact of early life events and conditions on late life mortality," MPIDR Working Papers WP-2002-019, Max Planck Institute for Demographic Research, Rostock, Germany.
    48. Jean Drèze & Mamta Murthi, 2001. "Fertility, Education, and Development: Evidence from India," Population and Development Review, The Population Council, Inc., vol. 27(1), pages 33-63, March.
    49. Schultz, T. Paul, 1988. "Education investments and returns," Handbook of Development Economics, in: Hollis Chenery & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 1, chapter 13, pages 543-630, Elsevier.
    50. Backlund, Eric & Sorlie, Paul D. & Johnson, Norman J., 1999. "A comparison of the relationships of education and income with mortality: the national longitudinal mortality study," Social Science & Medicine, Elsevier, vol. 49(10), pages 1373-1384, November.
    51. Mealli, Fabrizia & Rubin, Donald B., 2003. "Assumptions allowing the estimation of direct causal effects," Journal of Econometrics, Elsevier, vol. 112(1), pages 79-87, January.
    52. Andrea Brandolini & Anthony B. Atkinson, 2001. "Promise and Pitfalls in the Use of "Secondary" Data-Sets: Income Inequality in OECD Countries As a Case Study," Journal of Economic Literature, American Economic Association, vol. 39(3), pages 771-799, September.
    53. Ehrlich, Isaac, 1973. "Participation in Illegitimate Activities: A Theoretical and Empirical Investigation," Journal of Political Economy, University of Chicago Press, vol. 81(3), pages 521-565, May-June.
    54. Kawachi, Ichiro & Kennedy, Bruce P., 1997. "The relationship of income inequality to mortality: Does the choice of indicator matter?," Social Science & Medicine, Elsevier, vol. 45(7), pages 1121-1127, October.
    55. repec:pri:rpdevs:case_money_protect_nber is not listed on IDEAS
    56. Subramanian, Shankar & Deaton, Angus, 1996. "The Demand for Food and Calories," Journal of Political Economy, University of Chicago Press, vol. 104(1), pages 133-162, February.
    57. Angus Deaton, 2001. "Relative Deprivation, Inequality, and Mortality," NBER Working Papers 8099, National Bureau of Economic Research, Inc.
    58. LeClere, F.B. & Soobader, M.-J., 2000. "The effect of income inequality on the health of selected US demographic groups," American Journal of Public Health, American Public Health Association, vol. 90(12), pages 1892-1897.
    59. Cecilia Garcia-Penalosa & Eve Caroli & Philippe Aghion, 1999. "Inequality and Economic Growth: The Perspective of the New Growth Theories," Journal of Economic Literature, American Economic Association, vol. 37(4), pages 1615-1660, December.
    60. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 617-650.
    61. Sen, Amartya, 1997. "On Economic Inequality," OUP Catalogue, Oxford University Press, number 9780198292975, Decembrie.
    62. Stiglitz, Joseph E, 1976. "The Efficiency Wage Hypothesis, Surplus Labour, and the Distribution of Income in L.D.C.s," Oxford Economic Papers, Oxford University Press, vol. 28(2), pages 185-207, July.
    63. Gersovitz, Mark, 1983. "Savings and Nutrition at Low Incomes," Journal of Political Economy, University of Chicago Press, vol. 91(5), pages 841-855, October.
    64. Jennifer M. Mellor & Jeffrey D. Milyo, 2001. "Income inequality and health," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 20(1), pages 151-155.
    65. Lant Pritchett & Lawrence H. Summers, 1996. "Wealthier is Healthier," Journal of Human Resources, University of Wisconsin Press, vol. 31(4), pages 841-868.
    66. Jennifer M. Mellor & Jeffrey Milyo, 1999. "Re-Examining the Evidence of an Ecological Association between Income Inequality and Health," Discussion Papers Series, Department of Economics, Tufts University 9922, Department of Economics, Tufts University.
    67. Raghabendra Chattopadhyay & Esther Duflo, 2001. "Women's Leadership and Policy Decisions: Evidence from a Nationwide Randomized Experiment in India," Boston University - Department of Economics - The Institute for Economic Development Working Papers Series dp-114, Boston University - Department of Economics.
    68. Judge, Ken & Mulligan, Jo-Ann & Benzeval, Michaela, 0. "Income inequality and population health," Social Science & Medicine, Elsevier, vol. 46(4-5), pages 567-579, February.
    69. repec:dau:papers:123456789/10091 is not listed on IDEAS
    70. McLaughlin, D.K. & Stokes, C.S., 2002. "Income inequality and mortality in US counties: Does minority racial concentration matter?," American Journal of Public Health, American Public Health Association, vol. 92(1), pages 99-104.
    71. Shlomo Yitzhaki, 1979. "Relative Deprivation and the Gini Coefficient," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 93(2), pages 321-324.
    72. Rosenzweig, Mark R., 1988. "Labor markets in low-income countries," Handbook of Development Economics, in: Hollis Chenery & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 1, chapter 15, pages 713-762, Elsevier.
    73. Ulf-G. Gerdtham & Magnus Johannesson, 2004. "Absolute Income, Relative Income, Income Inequality, and Mortality," Journal of Human Resources, University of Wisconsin Press, vol. 39(1).
    74. Samuel H. Preston & Michael R. Haines, 1991. "Fatal Years: Child Mortality in Late Nineteenth-Century America," NBER Books, National Bureau of Economic Research, Inc, number pres91-1, January.
    75. Donohue, John J, III & Heckman, James, 1991. "Continuous versus Episodic Change: The Impact of Civil Rights Policy on the Economic Status of Blacks," Journal of Economic Literature, American Economic Association, vol. 29(4), pages 1603-1643, December.
    76. Jean Drèze & Reetika Khera, 2000. "Crime, Gender, and Society in India: Insights from Homicide Data," Population and Development Review, The Population Council, Inc., vol. 26(2), pages 335-352, June.
    77. Kawachi, I. & Kennedy, B.P. & Lochner, K. & Prothrow-Stith, D., 1997. "Social capital, income inequality, and mortality," American Journal of Public Health, American Public Health Association, vol. 87(9), pages 1491-1498.
    78. repec:pri:cheawb:deaton_relative_deprivation.pdf is not listed on IDEAS
    79. Swamy, Anand V., 1997. "A simple test of the nutrition-based efficiency wage model," Journal of Development Economics, Elsevier, vol. 53(1), pages 85-98, June.
    80. Ken Judge & Iain Paterson, 2001. "Poverty, Income Inequality and Health," Treasury Working Paper Series 01/29, New Zealand Treasury.
    81. Fogel, Robert William, 1993. "New findings on secular trends in nutrition and mortality: Some implications for population theory," Handbook of Population and Family Economics, in: M. R. Rosenzweig & Stark, O. (ed.), Handbook of Population and Family Economics, edition 1, volume 1, chapter 9, pages 433-481, Elsevier.
    82. Sen, Amartya, 1973. "On Economic Inequality," OUP Catalogue, Oxford University Press, number 9780198281931, Decembrie.
    83. Lynch, J.W. & Kaplan, G.A. & Pamuk, E.R. & Cohen, R.D. & Heck, K.E. & Balfour, J.L. & Yen, I.H., 1998. "Income inequality and mortality in metropolitan areas of the United States," American Journal of Public Health, American Public Health Association, vol. 88(7), pages 1074-1080.
    84. Lochner, K. & Pamuk, E. & Makuc, D. & Kennedy, B.P. & Kawachi, I., 2001. "State-level income inequality and individual mortality risk: A prospective, multilevel study," American Journal of Public Health, American Public Health Association, vol. 91(3), pages 385-391.
    85. Richard H. Steckel, 1995. "Stature and the Standard of Living," Journal of Economic Literature, American Economic Association, vol. 33(4), pages 1903-1940, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ken Judge & Iain Paterson, 2001. "Poverty, Income Inequality and Health," Treasury Working Paper Series 01/29, New Zealand Treasury.
    2. Owen O'Donnell & Eddy Van Doorslaer & Tom Van Ourti, 2013. "Health and Inequality," Tinbergen Institute Discussion Papers 13-170/V, Tinbergen Institute.
    3. Grönqvist, Hans & Johansson, Per & Niknami, Susan, 2012. "Income inequality and health: Lessons from a refugee residential assignment program," Journal of Health Economics, Elsevier, vol. 31(4), pages 617-629.
    4. Li, Hongbin & Zhu, Yi, 2006. "Income, income inequality, and health: Evidence from China," Journal of Comparative Economics, Elsevier, vol. 34(4), pages 668-693, December.
    5. Herzer, Dierk & Nunnenkamp, Peter, 2015. "Income inequality and health: Evidence from developed and developing countries," Economics - The Open-Access, Open-Assessment E-Journal (2007-2020), Kiel Institute for the World Economy (IfW Kiel), vol. 9, pages 1-56.
    6. Nicole Grunewald & Inmaculada Martínez-Zarzoso, 2014. "Green Growth in Mexico, Brazil and Chile: Policy strategies and future prospects," Ibero America Institute for Econ. Research (IAI) Discussion Papers 229, Ibero-America Institute for Economic Research.
    7. Lhila, Aparna, 2009. "Does government provision of healthcare explain the relationship between income inequality and low birthweight?," Social Science & Medicine, Elsevier, vol. 69(8), pages 1236-1245, October.
    8. Wilkinson, Richard G & Pickett, Kate E., 2006. "Income inequality and population health: A review and explanation of the evidence," Social Science & Medicine, Elsevier, vol. 62(7), pages 1768-1784, April.
    9. David Cantarero & Marta Pascual & Jose Maria Sarabia, 2004. "Can income inequality contribute to understand inequalities in health? An empirical approach based on the European Community Household Panel," ERSA conference papers ersa04p230, European Regional Science Association.
    10. Jennifer M. Mellor & Jeffrey Milyo, 2002. "Income Inequality and Health Status in the United States: Evidence from the Current Population Survey," Journal of Human Resources, University of Wisconsin Press, vol. 37(3), pages 510-539.
    11. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2006. "The Determinants of Mortality," Journal of Economic Perspectives, American Economic Association, vol. 20(3), pages 97-120, Summer.
    12. Tilman Tacke & Robert J. Waldmann, 2013. "Infant mortality, relative income and public policy," Applied Economics, Taylor & Francis Journals, vol. 45(22), pages 3240-3254, August.
    13. Jennifer M. Mellor & Jeffrey Milyo, 1999. "Re-Examining the Evidence of an Ecological Association between Income Inequality and Health," Discussion Papers Series, Department of Economics, Tufts University 9922, Department of Economics, Tufts University.
    14. Martin Ravallion, 2013. "The Idea of Antipoverty Policy," NBER Working Papers 19210, National Bureau of Economic Research, Inc.
    15. Herzer, Dierk & Nunnenkamp, Peter, 2011. "Income inequality and health: New evidence from panel data," Kiel Working Papers 1736, Kiel Institute for the World Economy (IfW Kiel).
    16. Thorbecke, Erik & Charumilind, Chutatong, 2002. "Economic Inequality and Its Socioeconomic Impact," World Development, Elsevier, vol. 30(9), pages 1477-1495, September.
    17. Vincent Hildebrand & Philippe Kerm, 2009. "Income inequality and self-rated health status: Evidence from the european community household panel," Demography, Springer;Population Association of America (PAA), vol. 46(4), pages 805-825, November.
    18. Deaton, Angus & Lubotsky, Darren, 2003. "Mortality, inequality and race in American cities and states," Social Science & Medicine, Elsevier, vol. 56(6), pages 1139-1153, March.
    19. Arnaud Lefranc & Nicolas Pistolesi & Alain Trannoy, 2008. "Inequality Of Opportunities Vs. Inequality Of Outcomes: Are Western Societies All Alike?," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 54(4), pages 513-546, December.
    20. Zheng, Hui, 2012. "Do people die from income inequality of a decade ago?," Social Science & Medicine, Elsevier, vol. 75(1), pages 36-45.

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:pri:cheawb:11. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Bobray Bordelon (email available below). General contact details of provider: https://edirc.repec.org/data/chprius.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.