(1) Correlation is not causation. But the correlation is incredibly persistent and robust, and exists even when all conceivable confounding variables have been controlled for. Nevertheless, our ability to draw causal inferences about as dynamic and complex a social phenomenon as health obviously cannot depend on deduction. Daniels et al, and other social epidemiologists, submit lengthy arguments explaining what they perceive to be the causal pathways.

(2) Is this a rhetorical question? If the social epidemiologists are correct — and of course this is a big if — then the implication is exactly what you suggested, that there is good reason to believe that reducing socioeconomic disparities is likely to have a greater aggregate impact on public health than virtually any other conceivable policies.

This, of course, hardly requires any kind of false forced choice analogy. No one is arguing that we should cease working to increase smoking prevention and cessation, etc. The argument is simply that reducing inequalities should be given a much higher priority as a public health strategy than it currently enjoys.

Finally, I’d add that making such policies a cornerstone of evidence-based public health practice may be foreign to American discourse, but is at the very core of many WHO public health initiatives.

http://www.nytimes.com/2005/06/26/realestate/26cov.html?ex=1185422400&en=b593a708ca7ccf18&ei=5070

Now perhaps that is a uniquely big-city type of story. But Frank also writes on how the growth of the exurbs leads to longer commutes and all the stress they entail. Again, the buying power of those who get larger and larger lots can contribute to a longer commute for all because it decreases density.

http://www.wired.com/gaming/gamingreviews/magazine/15-07/pl_games

and this discussion of the challenges of eating healthily while on food stamps:

http://www.radioopensource.org/taking-the-food-stamp-challenge/

I have been skeptical about the possibility of really distinguishing the “deserving” and “undeserving” sick, but Peter Schuck’s work on “bad apples” and “bad bets” is a good counterpoint to my view.

Michael: As for pt. 3, I think Warren’s article is a good one. I would have to study the mobility patterns more to provide a better answer about the relative ease of tier-to-tier jumping.

As for 1: yes, the “poor you will always have with you,” but the kinds of inequality we’ve recently been experiencing are pretty extreme if compared to the pattern of income distribution in the post-war period. (Frank’s book has a series of graphs indicating the percentage of income growth from about 1950 to 1975 or so, and it’s much more equal than the chart above).

1) Is there any reason to think that the relationship is causal, rather than merely correlational?

2) Even if there is any causal relationship at all, can it really be possible that the effect is so dominant that eliminating income inequality would be “one of the best ways” to improve public health — ahead of, say, reducing usage of drugs, tobacco, and alcohol; reducing intake of sugar and processed foods; increasing average level of exercise; and the like?

Anand, Sudhir, Peter Fabienne, and Amartya Sen, eds. Public Health, Ethics, and Equity (2004).

Dasgupta, Partha. An Inquiry into Well-Being and Destitution (1993).

Dreze, Jean and Amartya Sen. Hunger and Public Action (1989).

Dreze, Jean, Amartya Sen and Athar Hussain, eds. The Political Economy of Hunger: Selected Essays (1995).

Farmer, Paul. Infections and Inequalities: The Modern Plagues (1999).

Farmer, Paul. Pathologies of Power: Health, Human Rights and the New War on the Poor (2003).

Gauri, Varun. “Social Rights and Economics: Claims to Health Care and Education in Developing Countries,” in Alston, Philip and Mary Robinson, eds. Human Rights and Development: Towards Mutual Reinforceent (2005), 65-83.

Grusky, David B. and Ravi Kanbur, eds. Poverty and Inequality (2006).

Nussbaum, Martha C. and Amartya Sen, eds. The Quality of Life (1993).

Sen, Amartya. Poverty and Famines: An Essay on Entitlement and Deprivation (1981).

Sen, Amartya. Development as Freedom (1999).

Smith, Richard, et al., eds. Global Public Goods for Health (2003).

Anand, Sudhir, Peter Fabienne, and Amartya Sen, eds. Public Health, Ethics, and Equity (2004).

Dasgupta, Partha. An Inquiry into Well-Being and Destitution (1993).

Dreze, Jean and Amartya Sen. Hunger and Public Action (1989).

Dreze, Jean, Amartya Sen and Athar Hussain, eds. The Political Economy of Hunger: Selected Essays (1995).

Farmer, Paul. Infections and Inequalities: The Modern Plagues (1999).

Farmer, Paul. Pathologies of Power: Health, Human Rights and the New War on the Poor (2003).

Gauri, Varun. “Social Rights and Economics: Claims to Health Care and Education in Developing Countries,” in Alston, Philip and Mary Robinson, eds. Human Rights and Development: Towards Mutual Reinforceent (2005), 65-83.

Grusky, David B. and Ravi Kanbur, eds. Poverty and Inequality (2006).

Nussbaum, Martha C. and Amartya Sen, eds. The Quality of Life (1993).

Sen, Amartya. Poverty and Famines: An Essay on Entitlement and Deprivation (1981).

Sen, Amartya. Development as Freedom (1999).

Smith, Richard, et al., eds. Global Public Goods for Health (2003).

Questions:

1. Even though there are power differentials caused by inequality, won’t that always be true? Unless you have an entirely equal society won’t there always be a bottom fifth?

2. Some would say that so long as the entire pie grows we shouldn’t be concerned. Seeing the above numbers doesn’t really persuade me on that view, but I am wondering whether there is any research on how much growth we would see in the bottom three fifths by reduction in the top 2 fifths or even the top 1%.

3. While jumping into the top 1% requires the superstar/luck effect, is that really true for jumping from the bottom 2 tiers up a tier? Is it really spending and indebtedness and positional jockeying that are the cause of the ills for the bottom 40%?