Economic Inequality and Health in the Age of Globalization

The hypothesis that economic inequality is a determinant of health is still the source of heated debates in the literature. However, the weight of the evidence shows that unequal societies have almost always worse health outcomes than the more egalitarian ones. Two major mechanisms explain why inequality is associated with health: material deprivation and psychosocial factors. The conflicting evidence and interpretations of the income inequality hypothesis largely reflect a lack of theoretical development regarding the ways in which inequality affects health. The association between inequality and health as well as the plausibility of the two pathways need to be understood in the light of the bidirectional relationship between public policies and inequality. This is particularly true when examining the interrelations between the distribution of income and wealth worldwide and the trends in health status after the adoption of globalization policies. Since the advent of these reforms, economic inequality has sharply increased worldwide and the rise of inequality has, in turn, further consolidated the adoption of these policies through an increasing 'democratic deficit.' The reciprocal effects of inequality and globalization produced adverse health outcomes between and within societies through both material deprivation and psychosocial factors. Rather than producing isolated health effects, inequality interacts with policies creating multiple, indirect, and reciprocal pathways.