September 20, 2012

Low income linked to poorer health in both U.S. and England, despite different health systems

News and Information

Although the English are generally healthier than Americans, both countries grapple with large health inequalities. A new study suggests that in both countries, health and wealth are tightly linked.

The study, published online Sept. 20 in the American Journal of Public Health, links income level with obesity, diabetes, cardiovascular disease, asthma and other health conditions.

The results surprised author Melissa Martinson, an assistant professor at the UW’s School of Social Work, who expected income to have less of an effect on the health of English residents due to their access to publicly funded health care.

Instead, she found a similar connection between income and health in Americans and the English from childhood through later adulthood, and the link persisted regardless of other factors commonly associated with poor health, including ethnicity, body mass index, access to health insurance, smoking and alcohol consumption.

“It’s not just that those with low income don’t have access to health care,” Martinson said. “The results suggest that reducing health disparities requires attention to broader social conditions associated with income inequality, such as extra stressors and unhealthy living environments.”

Martinson used data from national health surveys that included 36,360 American and 55,783 English people, up to age 80 and with about an even mix of men and women.  She calculated prevalence rates and risk ratios of obesity, hypertension, diabetes, cholesterol levels, heart attack or angina, stroke and asthma.

In a previous study, Martinson found that Americans had poorer health than the English. Yet her new study demonstrates that the magnitude of health inequalities between low- and high-income people were the same in both countries. “This suggests that despite differences in health care systems, high income inequality translates directly into large health inequalities,” Martinson said.

She cautioned that while income disparities in health are similar in the U.S. and England, low-income Americans are less healthy than low-income English residents according to nearly all of the health measures she used.

Martinson suspects that this is because the British health care system improves health for the entire population. In her study, all low-income English residents — like the rest of the English population —received health care through the government, compared with about one-third of low-income Americans going without health insurance.

Martinson says that equal access to health care is an important first step in improving health in the U.S., but there is more work to be done. “We need a better understanding of why low income coincides with poor health so that we can develop policies and interventions that even out these inequalities,” Martinson said.

She did the research, funded in part by the U.S. National Institutes of Health, as a postdoctoral researcher at Princeton University.

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For more information, contact Martinson at melmart@uw.edu.

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