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Unpacking Income Inequality and Population Health: The Peculiar Absence of Geography

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Abstract

Background

A large and growing body of literature investigating the negative relationship between income inequality and population health (at different geographic scales) has developed over the past several years, although the relationship is not universal apparently. We argue that there has been a peculiar absence of geography in studies of the relationship between income inequality and population health and that explanations for the mixed results have been hampered by an inattention to geography.

Methods

Using methods of spatial pattern visualization, outlier analysis and comparative case study analysis, we investigate the role of “geography” as a means of “unpacking” the relationship between income inequality and health in Canada and the United States.

Results

The findings demonstrate how analyzing the study of income inequality and population health in the context of place makes otherwise obscure patterns visible and opens up new questions and opportunities for investigating how unequal places may be less healthy than more egalitarian ones. Rather than dismissing the importance of income inequality and health because it does not appear to exist at all times and in all places, we raise questions such as: Under what conditions does the relationship between income inequality and population health hold? and What, if anything, is similar about places where it does (or does not) hold? as crucial questions requiring a different kind of analysis than has been common in this literature.

Conclusion

We recommend that place and health studies seek this balance between universalistic and particularistic explanations of place and health relationships in order to best understand the socio-geographic production of health.

Résumé

Contexte

Depuis quelques années, des études toujours plus nombreuses portent sur la relation inverse entre l’inégalité des revenus et la santé des populations (à différentes échelles géographiques), mais cette relation ne semble pas universelle. Nous faisons valoir que les considérations géographiques brillent par leur absence dans les études des liens entre l’inégalité des revenus et la santé des populations, et que les explications des résultats mitigés de ces études souffrent du fait qu’on ne tient pas compte de la géographie.

Méthode

À l’aide de techniques de visualisation des structures spatiales, d’analyse des valeurs aberrantes et d’analyse comparative d’études de cas, nous avons étudié le rôle de la géographie comme moyen de « dégrouper » les liens entre l’inégalité des revenus et la santé au Canada et aux États-Unis.

Résultats

Notre analyse des études sur l’inégalité des revenus et la santé des populations dans le contexte du lieu a mis au jour des structures qui autrement seraient restées dans l’ombre et dégagé de nouvelles questions et de nouvelles pistes de recherche pour comprendre de quelle façon les lieux où les inégalités sont importantes peuvent être moins sains que les lieux égalitaires. Plutôt que de minimiser l’importance de l’inégalité des revenus pour la santé parce qu’un lien ne semble pas exister en tout temps et en tous lieux, nous sommes convaincus que certaines questions sont d’une importance cruciale et méritent une analyse différente de celle que l’on trouve dans les études sur le sujet. Ces questions sont les suivantes: Dans quelles conditions y a-t-il bel et bien un lien entre l’inégalité des revenus et la santé des populations? Et quelles sont les similitudes, le cas échéant, entre les lieux où un tel lien est présent (ou absent)?

Conclusion

Nous recommandons que les études sur le lieu et la santé cherchent à atteindre un équilibre entre les explications universelles et particulières des liens entre le lieu et la santé, afin d’accroître notre connaissance des mécanismes sociogéographiques de production de la santé.

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Authors and Affiliations

  1. Centre for Research on Inner City Health, St. Michael’s Hospital, 30 Bond. St., Toronto, Ontario, Canada M5B 1W8, Canada

    James R. Dunn PhD

  2. Departments of Geography & Planning and Public Health Sciences, University of Toronto, Canada

    James R. Dunn PhD

  3. Centre for Health Services and Policy Research, University of British Columbia, Canada

    Peter Schaub BA

  4. Department of Geography, McGill University, Canada

    Nancy A. Ross PhD

Authors
  1. James R. Dunn PhD
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  2. Peter Schaub BA
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  3. Nancy A. Ross PhD
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Correspondence to James R. Dunn PhD.

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Dunn, J.R., Schaub, P. & Ross, N.A. Unpacking Income Inequality and Population Health: The Peculiar Absence of Geography. Can J Public Health 98 (Suppl 1), S10–S17 (2007). https://doi.org/10.1007/BF03403722

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