Does Inequality Kill?

In 1839, a study of some 1,600 deaths in a London suburb – the first of its kind – revealed that those at the top of society lived, on average, 2.5 times longer than mechanics and laborers and their families. Since then, little has changed. Despite dramatic improvements in social and health conditions which have boosted the life expectancy among all socioeconomic groups, the rich continue to outlive the poor. One recent study found that those with the lowest education and income were 2-3 times more likely to die during the next ten years than those at the top. Diseases when suffered by the poor appear to be more deadly than when they afflict better off people. The less affluent, indeed, are more likely to die from cardiovascular disease, stroke, several forms of cancer, AIDS, diabetes, chronic lung disease, pneumonia, influenza, cirrhosis, accidents, homicide, and suicide than people who are rich. What is perhaps the most striking is that this phenomenon is not just a question of rich vs. poor. Differences in life expectancy operate at every socioeconomic level, so that, for example, people nearly at the top of the economic scale – and thus quite well off – do not live as long as those just above them. Why this pattern exists remains in large part a mystery. To be sure, the poor are less well educated and so are less knowledgeable about how to take care of themselves; they also live in generally worse conditions. They are more susceptible to the effects of unhealthy diets, overcrowding, unsafe working conditions, and exposure to environmental hazards. They are also more vulnerable to interpersonal aggression and risky behavior – a point not lost on marketers and suppliers of cigarettes, alcohol, drugs, guns, and junk food. But the impact of those things we usually associate with poverty – bad diet, crowding, environmental toxins, health-adverse habits, etc. – account for only about 25% of the difference in life expectancy between those at the top and those at the bottom of the socioeconomic ladder. The remaining 75% of the variation appears to be due not to absolute levels of deprivation, but to less tangible causes that reflect