Health, Income, and Poverty

Strong evidence linking income and health suggests that policies promoting economic equity may have broad health effects.

What's the Issue?

Poverty has long been recognized as a contributor to death and disease, but several recent trends have generated an increased focus on the link between income and health. First, income inequality in the United States has increased dramatically in recent decades, while health indicators have plateaued, and life expectancy differences by income have grown. Second, there is growing scholarly and public recognition that many nonclinical factors—education, employment, race, ethnicity, and geography—influence health outcomes. Third, health care payment and delivery system reforms have encouraged an emphasis on addressing social determinants of health, including income.

In this brief, researchers review the evidence supporting the income-health relationship and the likely mechanisms through which income affects health. They go on to discuss the growing importance of this association, given widening income inequality, and discuss policy levers that might help reduce income-related health disparities.

• Income is strongly associated with morbidity and mortality across the income distribution, and income related health disparities appear to be growing over time. 
• Income influences health and longevity through various clinical, behavioral, social, and environmental mechanisms. Isolating the unique contribution of income to health can be difficult because this relationship intersects with many other social risk factors.
• Poor health also contributes to reduced income, creating a negative feedback loop sometimes referred to as the health-poverty trap.
• Income inequality has grown substantially in recent decades, which may perpetuate or exacerbate health disparities.
• Policy initiatives that supplement income and improve educational opportunities, housing prospects, and social mobility—particularly in childhood—can reduce poverty and lead to downstream health effects not only for low-income people but also for those in the middle class.

What's Next?

More research is needed to understand the most effective ways to reduce poverty and disrupt the link between low income and poor health. Research should explore the effect of policies that increase educational opportunity and economic mobility, including targeted incentive programs. For example, regressive “sin taxes” are often imposed for unhealthy behavior such as tobacco use, but the differential effects of financial incentives to encourage smoking cessation among low-income people are now also being explored. 

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