Benjamin Franklin's adage linking health and wealth has persisted through time, suggesting that financial security correlates with better health and increased lifespan. A recent study delves into this relationship, specifically exploring the impact of wealth inequality on longevity in the U.S. and considering potential increases in lifespan associated with reduced wealth inequality.
Wealth Inequality
Before jumping into the study's findings, it's essential to grasp the context of wealth in the United States. The country exhibits high and escalating levels of wealth inequality, with the wealthiest 10% holding a staggering 70.7% of total wealth. [1] This stark contrast is uncommon among high-income nations, with racial wealth disparities also prominently present. White households, for instance, possess nearly six times the wealth of Latino households and seven times that of Black households.
Distinguishing Wealth from Income
It's crucial to differentiate between wealth and income when assessing an individual's financial situation. Income refers to the regular money flow into a person's or family's budget, while wealth encapsulates accumulated assets and resources, including tangible items like real estate and vehicles. The study emphasizes that wealth may more meaningfully capture socioeconomic position than income, considering its stability over time and its influence on access to essential resources such as housing and education.
Wealth is more reflective of caste, a social stratification that traditionally divides society into distinct groups, often based on factors such as occupation, birth, and heredity. We will return to wealth as caste in a moment.
The Study
The study utilized data from the Health and Retirement Study (HRS), a longitudinal panel study of US adults aged 50 or older that collects detailed but estimated data on household wealth [2]. The sample, consisting of 35,164 participants, was divided into wealth deciles ranging from the lowest to the highest. The researchers calculated survival rates for each decile and applied various wealth distribution models to explore potential changes in longevity.
The four wealth distribution models included:
- Equalizing wealth in the US to a specific amount, $281,767, the seventh decile of wealth. [3]
- Adopting a wealth distribution similar to Japan, a country with the lowest wealth inequality of high-income countries.
- Implementing a minimum inheritance policy, where each adult receives an inheritance equal to 60% of the national per-person wealth,$169,060. [4]
- Introducing a baby bonds proposal involving a $1,000 deposit for newborns, with additional deposits based on household income to poverty ratio. [5]
Results and Implications
Adjustments in the HRS data were made for age, self-reported sex, race and ethnicity, marital status, and household size. As expected, based on many studies of demographics and health, a lower hazard of death was identified for female sex, being married (or partnered), and greater wealth – the gap from lowest to highest deciles 13.5 years.
Latin participants had a lower hazard of death relative to White participants in all models, and greater income and education levels were associated with a lower hazard of death. Black participants had a greater hazard of death when adjusted for education or income alone but not in models adjusted for wealth. Both findings speak against the idea that race or ethnicity, on its own, is the determinant of health; it is entangled with wealth – it is a matter of caste, and caste is racially diverse.
“Simulations of more equitable wealth distributions were associated with large increases in longevity for the entire population, ranging from 1.0 to 2.2 years, a 4% to 10% increase … equivalent in magnitude to the population-wide gains in life expectancy between 2005 and 2015 or to the losses in life expectancy during the COVID-19 pandemic.”
The analysis revealed that simulations of more equitable wealth distributions were associated with significant increases in longevity, ranging from 1.0 to 2.2 years. Perfect wealth equity, “unlikely to be politically achievable,” produced the most significant longevity increase of 2.2 years. This was followed by wealth equality modeling in Japan, 1.7 years, a minimum inheritance policy, 1.6 years, and the baby bonds proposal, 1 year.
Connecting Wealth to Health – is Caste a better description?
“…our analysis suggests that wealth may mediate a large share of survival gaps between Black and White individuals, as Black study participants did not have a greater hazard of death in models adjusting for wealth. These findings suggest that Black households might experience particularly large health benefits from society wide wealth redistribution.” [emphasis added]
However, does wealth mediate that difference or capture many responsible underlying factors?
Notably, the study emphasizes the potential health benefits of societal wealth redistribution, particularly for Black households. I believe this conflates mediation with representation.
The study posited several mechanisms through which wealth could improve health, including facilitating residence in well-funded neighborhoods, providing access to quality education and healthcare, and increasing leisure time for health-promoting activities.
I would argue that wealth stands in for all those mechanisms, so simply equalizing wealth does not result in equalized housing, education, and lifestyle. More importantly, while there were disparities in the racial makeup of the lowest wealth group, there was no evidence that being White and poor was any less a determinant of poor health than being black or brown and poor. Caste is a better descriptor if for no other reason than it removes the divisive use of race from the discussion, allowing us to stop acting based on “the color of their skin” and more on fundamental determinants of our lives, our homes, neighborhoods, education, and food.
Improving longevity is not a matter of transferring wealth or paying reparations.
Wealth redistribution is not a panacea. It requires, as the commentary on this study notes,
“Complementary public policy changes in other sectors, such as housing, education, the environment, and the criminal justice system…”
that will address the broader determinants of health and enhance the well-being of all individuals.
[1] The top 1% of US households own 42.5% of total wealth vs. 27.8% in the Netherlands, the second most unequal OECD (Organization for Economic Cooperation and Development) country.
[2] Assets queried included primary and secondary residences; other real estate; vehicles; businesses; stocks; mutual funds; investment trusts; checking, savings, money market, individual retirement, and Keogh accounts; certificates of deposit; government savings bonds; Treasury bills; bonds; bond funds; and other savings. Debts included mortgages and land contracts on residences, home loans, and other debt (e.g., credit card balances and medical debt).
[3] The value of $281,767 was based on Federal Reserve and Census Bureau estimates of mean household net worth and household size.
[4] The researchers “assigned a minimum wealth of $169,060 (60% of $281,767) to each individual in the sample without changing the wealth of any individual whose actual wealth was greater than $ 169,060.”
[5] This reflects actual legislation proposed by US Representative Ayanna Pressley and Senator Cory Booker.
Source: Wealth Redistribution to Extend Longevity in the US JAMA Internal Medicine DOI:10.1001/jamainternmed.2023.7975
