The Devastating Effects of Income Disparity on Mental illness and Mortality

Last summer, I reported the effects of poverty on mental illness (see https://www.behavioral.net/blogs/ron-manderscheid/breaking-chains-mental-illness-bind-those-poverty). This analysis shows very clearly that poverty increases the likelihood that one will experience a mental illness, which subsequently will then trap the person in poverty. Poverty exerts these negative effects principally through the physical, sexual, emotional and psychological trauma experienced by those who are subjected to poverty.

More recently, in the just-released 2014 Shriver Report, A Woman’s Nation Pushes Back from the Brink (see: www.shriverreport.org), I reported the relationship between poverty and mental illness for women. The rate of poverty among women is higher than for men, and almost half of all women in poverty have a mental illness,  especially depression, post traumatic stress disorder, or anxiety disorder--each a condition that can be exacerbated by substance use. For these women, mental illness becomes a trap because it leads to increased social isolation and reduced energy. To address this problem for these women, appropriate opportunities—career trajectories, female mentors, etc.--need to be developed to create pathways out of poverty. 

Here, I would like to extend my earlier work to the effects of income disparity on mental illness and mortality. During the last quarter century, since the late 1970s, the disparity in incomes in the United States has grown dramatically between those with the largest and smallest incomes. In 2012, Paul Wiseman found that the very top 1 percent earned more than 19 percent of the country's household income--the biggest share since the 1920s. At the same time, the top 10 percent captured almost half of all earnings. Such income disparities are larger in the United States than in any other developed country. My expectation is that these very large income disparities produce trauma for those with the smallest incomes by negatively affecting the latters’ self-esteem and sense of mastery over the environment, both of which then adversely impact upon their health, mental health, and life span.

Health Effects of Income Disparities. Recent work shows clearly that income disparities have adverse effects on the health and well-being of those with the smallest incomes. In an international comparison, Richard Wilkinson and Kate Pickett found higher rates of health and social problems (mental illness, drug use, obesity, homicides, teenage births, incarceration, and child conflict), and lower rates of social goods (life expectancy, educational performance, women’s status, and social mobility) in countries and U.S. states with higher income disparities. Statistics from 23 developed countries and the 50 U.S. states show social and health problems to be smaller in countries like Japan and Finland, and states like Utah and New Hampshire with higher levels of equality, than in countries like the U.S. and U.K., and states like Mississippi and New York, with large differences in household income. These authors argue that disparities and social differentiation lead to higher levels of psychosocial stress and status anxiety, which can lead to depression, chemical dependency, less community life, parenting problems and stress-related diseases. In further support of this conclusion, a recent Gallup Survey of 200,000 Americans found the following negative health consequences among those with the lowest incomes, when compared to persons with the highest incomes: depression (19% greater); high blood pressure (13% greater); obesity (10% greater);  and diabetes (10% greater).   

Mortality Effects of Income Disparities. Similarly, the effects of income disparities on mortality are quite stark. Lynch and others have noted that higher income disparity is associated with increased mortality at all per capita income levels. Further the relationship between income disparity and mortality actually is much stronger than that between per capita income and mortality. On average, income disparity accounts for a mortality differential 4 times as large (about 110 deaths per 100,000) as per capita income (about 30 deaths per 100,000). In the extreme, areas with high income disparity and low average income had excess mortality of 140 deaths per 100,000 compared with areas with low disparity and high income. To underline the importance of this statistic, Lynch and colleagues note that the magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide. 

Our Next Steps. Income disparity has very obvious and compelling negative effects on the mental health, health, and longevity of those who receive the smallest incomes. Within the past month, President Obama and Pope Francis, an unlikely duo, have independently raised red flags about the corrosive effects of these disparities, not only on individual people, but also on our social fabric and on our economy itself.  We must not ignore these important warning signs.

We must begin by advocating for a higher minimum wage. Currently, 15 states are considering increases. Some may say that this is not the task of behavioral health. Nothing could be further from the truth. Income disparity can lead to serious mental illness and substance use conditions. For this reason, addressing income disparity is our task.

Advocacy is not a part-time avocation to be done by volunteering on Saturday morning or by making a small financial contribution. Advocacy is 24/7. You understand this as well as I do. Let’s do it!