Sunday, July 04, 2010

Inequality and Health: The Causal Link

Via Andrew Gelman's blog, Lane Kenworthy posts a sceptical review of Wilkinson and Pickett's book "The Spirit Level".
 "It wouldn’t be surprising to find that inequality in the income distribution contributes to inequality in health, education, and so on. And there’s plenty of evidence that it does. Wilkinson and Pickett make a different claim: income inequality worsens the average level of health, education, safety, trust, and other good things"
At the heart of the debate is whether the cross-sectional associations between national levels of poor health and income inequality support the contention that more income inequality in society causes poorer health. Kenworthy is not convinced that they have demonstrated this and therefore not convinced that targetting income inequality is the best strategy for improving population health.
"I share Wilkinson and Pickett’s conviction that it would be good for America and some other affluent nations to reduce income inequality, but this book hasn’t convinced me that doing so would help us to make much headway in improving health, safety, education, and trust. To achieve those gains, my sense is that our best course of action is greater commitment to specialized programs and services, coupled with poverty reduction."


Anonymous said...

He's right. Whatever you think of inequality as a political issue, The Spirit Level scrapes the barrel of pseudo-science in its effort to push a left-wing agenda. The various critiques of The Spirit Level are far more convincing than anything in the book itself, but I guess people will believe what they want to believe.

David Madden said...

I think the best review of the Wilkinson and Pickett hypothesis is the recent chapter in the Oxford Handbook of Economic Inequality by Leigh, Jencks and Smeeding. Their conclusion is that current data (pretty much all cross-sectional) is not rich enough to test the hypothesis. What is needed is panel data and as yet there is not a rich enough panel data set available. They don't deny that the hypothesis may not be true, just that at present we don't have the sort of evidence which economists/econometricians would find compelling.