Health equity is declining as income inequality grows, JAMA study shows

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As income inequality worsens in America, the health of its less-fortunate patients continues to decline.

As income inequality worsens in America, the health of its less-fortunate patients continues to decline, according to a new study conducted by researchers with the Centers for Disease Control and Prevention (CDC).

The study, published this month in JAMA Network Open, collected survey data from the CDC from 1993 to 2017, which included 5.5 million Americans ages 18-64. Researchers asked individuals questions about their overall health during a one-month period and used it to assess trends in health equity based on race, gender, and income level.

Despite the national goal to increase health justice and equity-the idea that every patient should have a fair opportunity to be healthy regardless of their income, race or gender- the authors conclude that the situation has only worsened.

“Improving health equity often figures as an important goal for communities, thought leaders, and policy makers in public health,” the researchers write. “Yet, this analysis suggests that across the past 25 years, the promise of improving health equity has not been met. Greater or different efforts than those tried in the past will have to be mustered if health equity is to improve.”

The researchers found that only 10 percent to 20 percent of healthcare outcomes were determined by the provision of healthcare services, and that living conditions, education, income and other social determinants played a much larger role.


Frederick Zimmerman, the study's lead author and a professor at the UCLA Fielding School of Public Health, told NPR that health outcomes for wealthy people remain stable-or stagnant-but the health of the lowest income groups is “declining substantially over time.”

For example, research shows that low education accounts for the same number of deaths as heart attacks. In addition, it could also be beneficial for the health of the population to address concerns in a person’s environment like lead paint or a pest infestation.

“The results of this study show a worrisome lack of progress on health equity during the past 25 years in the United States,” the researchers write. “Achieving widely shared goals of improving health equity will require greater effort from public health policy makers, along with their partners in medicine and the sectors that contribute to the social determinants of health.”

The authors conclude that effective policy solutions to reduce poverty would be a “clear starting point to improving health equity.”