Apologists for wealth inequality often argue that inequality is a poor measure of whether a society is just or not: in the gospel of the right, society naturally forms hierarchies with the "best people" at the top (depending on what kind of right winger you are, that's either rich people or male people or white people or straight people, or some combination thereof), and they proceed to bring prosperity to all of us by ordering us around and telling us what to do, so that their wisdom can be played out for the world (see also: "job creators").
In this framework, the reason that the "best people" are accumulating so much more than the rest of us is that the natural mechanisms of providence (or market forces, depending on how much of a Christian you're pretending to be) reward them for all the progress they contribute to.
Instead of asking whether the best people have more than the rest of us, the argument goes, you should ask how the rest of us are doing under their wise stewardship: is our quality of life improving? Is our egalitarian impulse really a self-defeating form of jealousy (pulling down all those ubermenschen to our lumpenproletariat status, thus depriving everyone of the bounty their leadership might bestow upon us), or are things really getting worse?
Well, in health, the argument is settled. For years, statisticians and public health experts have noticed a widening health gap that tracked to the widening wealth gap. In the right's framing, this gap would be the result of everyone being healthier, with rich people being healthier poor people. The rising tide would be lifting all boats, but the people responsible for those tides — the wealthy — were rising higher than the rest of us.
But that's not what's happening. According to a study in JAMA Network Open published last month that analyzed longitudinal survey data collected by the CDC since 1993, the health of wealthy people is stagnant, while the health of poor people is declining, and this trend is now a quarter-century old.
Research shows that health care accounts for only 10% to 20% of overall health outcomes. Social determinants, or our living conditions and the factors driving them, account for the rest.
For instance, studies have found that low education is attributable to the same number of deaths as heart attacks. One 2016 study showed that the average life expectancy of U.S. men in the bottom 1% of income distribution is roughly equivalent to the life expectancy of someone in Sudan or Pakistan, whereas men in the top 1% of income outlive the average man in all other countries.
To make real progress on health inequities, communities have to address life conditions that contribute to poor health, Moore says. In their own work, Moore and Girard use legal strategies to ease the stress of their patients' lives. For instance, when patients living in public housing have problems like pest infestations or lead paint, their team finds them attorneys to hold their landlords to account.
Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017
[Frederick J. Zimmerman and Nathaniel W. Anderson/JAMA Network Open]
The Gap Between Rich And Poor Americans' Health Is Widening [Susie Neilson/NPR]