Department of Health Sciences, University of York, York, UK.
Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Soc Sci Med. 2015 Mar;128:316-26. doi: 10.1016/j.socscimed.2014.12.031. Epub 2014 Dec 30.
There is a very large literature examining income inequality in relation to health. Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. More recent studies, not included in those reviews, provide substantial new evidence. Our purpose in this paper is to assess whether or not wider income differences play a causal role leading to worse health. We conducted a literature review within an epidemiological causal framework and inferred the likelihood of a causal relationship between income inequality and health (including violence) by considering the evidence as a whole. The body of evidence strongly suggests that income inequality affects population health and wellbeing. The major causal criteria of temporality, biological plausibility, consistency and lack of alternative explanations are well supported. Of the small minority of studies which find no association, most can be explained by income inequality being measured at an inappropriate scale, the inclusion of mediating variables as controls, the use of subjective rather than objective measures of health, or follow up periods which are too short. The evidence that large income differences have damaging health and social consequences is strong and in most countries inequality is increasing. Narrowing the gap will improve the health and wellbeing of populations.
有大量文献研究了收入不平等与健康之间的关系。早期的综述对证据有不同的解释，但绝大多数研究报告表明，在不平等程度更高的社会中，健康状况往往更差。最近的一些研究没有包含在这些综述中，提供了大量新的证据。我们在本文中的目的是评估收入差距的扩大是否会导致更糟糕的健康状况，即是否存在因果关系。我们在流行病学因果框架内进行了文献综述，并通过综合考虑证据，推断收入不平等与健康（包括暴力）之间是否存在因果关系。证据强烈表明，收入不平等会影响人口的健康和福祉。主要的因果标准，如时间性、生物学合理性、一致性和缺乏其他解释，都得到了很好的支持。在少数没有发现关联的研究中，大多数可以用以下原因来解释：收入不平等是在不适当的尺度上衡量的，将中介变量作为控制因素包括在内，使用主观而非客观的健康衡量标准，或随访时间太短。收入差距对健康和社会造成严重后果的证据确凿，而且大多数国家的不平等程度都在增加。缩小差距将提高人口的健康和福祉。
