Long-term exposure to income inequality: implications for physical functioning at older ages
- 580 Downloads
The ‘inequality hypothesis’ proposes that higher levels of societal income inequality have a direct negative causal effect on health. Support for this hypothesis has been mixed; particularly among older people. However, most previous studies have not accounted for people’s exposure to inequality over the long-term. We aimed to address this problem by examining the implications of long-term inequality exposure for older people’s physical health. Data on individual health and covariates were drawn from three large, comparable surveys of older people, covering 16 countries: the English Longitudinal Study of Ageing, the Survey of Health and Retirement in Europe and the U.S. Health and Retirement Study. Historical inequality information was derived from the Standardised World Income Inequality Database. We used multilevel regression methods to model the association between long-term average inequality and three measures of physical functioning: grip strength, lung function and self-reported activity limitation. Exposure to higher average long-term levels of inequality was significantly negatively related to objectively measured grip strength and lung function, but unrelated to self-reported limitations (although increasing inequality over time was positively related to self-reported limitations). The grip strength and lung function associations were partially explained by between-country differences in height, and in the latter case this factor may fully account for the apparent effect of inequality. We discuss implications of these results for the inequality hypothesis.
KeywordsOlder people Income inequality Physical functioning Lag-times Inequality hypothesis
This article uses data from SHARE wave 2, release 2.50. The SHARE data collection has been primarily funded by the European Commission through the 5th Framework Programme (project QLK6-CT-2001-00360 in the thematic programme Quality of Life), through the 6th Framework Programme (projects SHARE-I3, RII-CT-2006-062193, COMPARE, CIT5-CT-2005-028857, and SHARELIFE, CIT4-CT-2006-028812) and through the 7th Framework Programme (SHARE-PREP, No. 211909, SHARE-LEAP, No. 227822 and SHARE M4, No. 261982). Additional funding from the U.S. National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11 and OGHA 04-064) and the German Ministry of Education and Research as well as from various national sources is gratefully acknowledged (see www.share-project.org for a full list of funding institutions). The authors would also like to thank Frederick Solt for creating the Standardised World Income Inequality Database, and colleagues from the International Centre for Life-course Studies in society and health for their assistance with a number of aspects of this Project.
During the course of this project, the authors were funded by the UK Economic and Social Research Council (ESRC), RES-596-28-0001.
Conflict of interest
The authors declare that they have no conflict of interest.
- Borsch-Supan A, Brugiavini A, Jurges H, Mackenbach J, Siegrist J, Weber G (2005) Health, ageing and retirement in Europe—first results from the survey of health, ageing and retirement in Europe. SHARE project. http://www.share-project.org/uploads/tx_sharepublications/BuchSHAREganz250808.pdf. Accessed 26 Jan 2010
- Kapteyn A (2008) Comparison between SHARE, ELSA, and HRS. In: Borsch-Supan A, Brugiavini A, Jurges H, Kapteyn A, Mackenbach J, Siegrist J, Weber G (ed). First results from the Survey of Health, Ageing and Retirement in Europe (2004–2007). SHARE project. http://www.share-project.org/uploads/tx_sharepublications/BuchSHAREganz250808.pdf. Accessed 26 Jan 2010
- Kawachi I, Kennedy BP (1999) Income inequality and health: pathways and mechanisms. Health Serv Res 34(1):215–227Google Scholar
- Kondo N, Sembajwe G, Kawachi I, Van Dam RM, Subramanian SV, Yamagata Z (2009) Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ 339(7731):1778–1781Google Scholar
- Marmot M, Banks J, Blundell R, Lessof C, Nazroo J (2003) Health, wealth and lifestyles of the older population in England: The 2002 English Longitudinal Study of Ageing. Institute for Fiscal Studies. http://www.ifs.org.uk/publications/3088. Accessed 20 July 2010
- Mascie-Taylor N (1991) Biosocial influences on stature: a review. J Biosoc Sci 32(01):113–128Google Scholar
- OECD (2008) Growing unequal? Income distribution and poverty in OECD countries. OECD publications. http://www.oecd.org/document/4/0,3343,en_2649_33933_41460917_1_1_1_1,00.html. Accessed 15 Dec 2010
- OECD (2009) Adjusting household incomes: equivalence scales. OECD publications. http://www.oecd.org/dataoecd/61/52/35411111.pdf. Accessed 20 May 2010
- Pfarr C, Schmid A, Schneider U (2011) Reporting heterogeneity in self-assessed health among elderly Europeans: the impact of mental and physical health status. University of Bayreuth Discussion paper No. 02–11Google Scholar
- Shi L, Macinko J, Starfield B, Xu J, Regan J, Politzer R, Wulu J (2004) Primary care, infant mortality, and low birth weight in the states of the USA. J Epidem Commun Health 58(8):1958–1964Google Scholar
- UNESCO (2006) ISCED-97 International Standard Classification of Education, May 2006 Re-ediction. UNESCO. http://www.unesco.org/education/information/nfsunesco/doc/isced_1997.htm. Accessed 10 May 2010
- Wilkinson RG (2005) The impact of inequality: how to make sick societies healthier. The New Press, New YorkGoogle Scholar
- Wilkinson R, Pickett K (2009) The spirit level: why more equal societies almost always do better. Allen Lane, LondonGoogle Scholar