Follow the Data: To Improve Health, Tackle Inequality

January 27, 2016
  • Andrew Matthews

    Former Manager, BSR

It has been two years since Thomas Piketty released Capital in the Twenty-First Century, a ground-breaking work that explains the relationship between income, economic stability, and equality. As political scientist Robert Reich explains in his documentary “Inequality for All,” periods of extreme income concentration historically occurred just prior to major crashes in the U.S. economy, such as 1928 and 2007. Periods of more equal distribution of wealth corresponded to more widespread prosperity.

Income today is concentrated in the top 1 percent at levels not seen since the early part of the 20th century in the United States. I use Piketty’s data to recreate his well-known visualization below.

Concentration of Income in the Top 1 Percent in the United States (1913-2014)


Further, income correlates to demographic factors—differences in educational background, race, and gender are linked to income inequality. Several notable studies illustrate this point. For instance, research sponsored by the Russell Sage Foundation has shown that the gap in reading achievement between high- and low-income students has increased from 1947 to 2002. Wealth inequality has widened along racial lines in the recent past, according to the Pew Research Center. And a 2012 report by the U.S. Bureau of Labor Statistics revealed that women earn much less than men do. Without making a claim about causality one way or the other, we can conclude that these factors are correlated.

But this story is not about how the U.S. economy has become increasingly unequal along socioeconomic and demographic lines. Rather, it is about how inequality affects our health and why health must be part of the inclusive economy conversation.

Our health does not exist in a vacuum. While behaviors including diet, exercise, smoking, and drinking influence health outcomes, many factors not related to lifestyle influence our health. Taking a close look at the drivers of health outcomes, it is difficult to ignore the socioeconomic determinants involved, including income and education. In short, the more socioeconomically disadvantaged a group of people may be, the worse health outcomes the group has.

Reviewing obesity rates as a proxy for health is instructive. The Centers for Disease Control and Prevention’s nationwide health survey, “The Behavioral Risk Factor Surveillance System,” collects information on risk behaviors, chronic health conditions, and preventive services. I visualize the data below, which tells a provocative story about health and inequality.

Comparing age cohorts in different income bands, obesity rates decline as income rises: They are negatively correlated. In other words, poverty is linked to higher rates of obesity.

Obesity Rates by Income and Age Cohort


Education is an influential factor for health as well. Building on findings shared earlier in this post, the more educated a population, the more healthy it tends to be.

Obesity Rates by Education Level and Age Cohort


While a more in-depth study is required on race and health, the chart below indicates that African Americans experience different health outcomes than non-Hispanic white populations.

Obesity Rates by Race and Age Cohort


Finally, there are asymmetric health impacts for women. Women tend to experience worse health outcomes in general than their male counterparts, when comparing obesity rates by income, education level, and race.

Obesity Rates by Income, Education Level, and Race with Gender Overlay


The causal relationship between any one of these factors and health is subject to lengthy investigation, but we can say that these factors matter. Improving health requires more than taking personal responsibility or making the right individual choices. It requires more than building clinics and providing access to medicines, though these interventions are a critical piece of the solution. Improving health requires systemic solutions that address the determinants of health as well as the outcomes. Unequivocally, to tackle health, we need to create an inclusive economy.

This task is a daunting challenge—one that requires significant cross-sector collaboration. But there are steps that companies can take now to invest in an inclusive economy and improve health in the United States.

In my next blog on health, I will lay out BSR’s approach to help companies create solutions that contribute to an inclusive economy, thereby improving health.

Let’s talk about how BSR can help you to transform your business and achieve your sustainability goals.

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