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At the Intersection of Health, Health Care and Policy Cite this article as: Michael Marmot The Influence Of Income On Health: Views Of An Epidemiologist Health Affairs, 21, no.2 (2002):31-46 doi: 10.1377/hlthaff.21.2.31

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The Influence Of Income On Health: Views Of An Epidemiologist Does money really matter? Or is it a marker for something else? by Michael Marmot
ABSTRACT: Income is related to health in three ways: through the gross national product of countries, the income of individuals, and the income inequalities among rich nations and among geographic areas. A central question is the degree to which these associations reflect a causal association. If so, redistribution of income would improve health. This paper discusses two ways in which income could be causally related to health: through a direct effect on the material conditions necessary for biological survival, and through an effect on social participation and opportunity to control life circumstances. The fewer goods and services are provided publicly by the community, the more important individual income is for health. Under present U.S. circumstances, a policy of counteracting growing income inequalities through the tax and benefit system and of public provision appears justified.

INCOME & HEALTH

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oes money matter for health? If so, why? If it does matter, there are at least three ways in which it could be important: not having enough money, maldistribution of money, and spending it on the wrong things. It is also possible that health could matter for money, that the causal direction could be the other way around. Of course, money could only appear to matter. It may be that poor people have worse health not because they have insufficient money but for some other reason. Similarly, a society characterized by a high degree of income inequality could have poor average health for reasons other than the distribution of income. Or countries that spend more money on surgeons may have better health because they are democratic, not because of the surgery. In each of these cases, money appears to matter because it is a marker for something else. Michael Marmot is professor and head of the Department of Epidemiology and Public Health, and director of the International Centre for Health and Society, at University College London. He was a member of the Scientific Advisory Committee, which prepared the 1998 Independent Inquiry into Inequalities in Health, under the leadership of Sir Donald Acheson. In 2000 Marmot was awarded a knighthood “for services to epidemiology and understanding health inequalities.”

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In come & Health

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