Is Inequality Bad for Our Health?

""We have long known that more affluent and better-educated members of a society tend to live longer and healthier,"" state the authors at the outset of the essay at the heart of this slim volume. They aim to recast the debate about health care in America. Instead of just worrying about cost and access, Daniels, Kennedy and Kawachi argue that in order to deal with health inequalities, we need to remedy the problem of income inequality."" In making this argument, the three academics (Daniels is a philosopher; Kennedy and Kawachi are public health scholars) draw both on broad-brush statistics (showing, for instance, that states with fairer income distributions boast better health) and on philosopher John Rawls's influential theory of justice. Along the way, they recommend four policy proposals: early childhood interventions; nutritional supplements for poor women and children; changes in the workplace environment; and income redistribution. In a series of responses to this essay, several scholars--such as Marcia Angell, the editor-in-chief of the New England Journal of Medicine--take issue with aspects of the authors' proposal, arguing, for example, that the social causes of poor health (wealth? occupation?) remain unclear; that their argument ignores differentials based on gender or race; and perhaps most potently, that their ""utopian"" plan nudges aside the ""doable but difficult task of making medical care more fairly distributed."" Still, the basic point proposed by Daniels, Kennedy and Kawachi--that good health depends mainly on factors outside the health care sector--should prompt a more textured debate on health policy. (Sept.)