School
School of Public Health
Document Type
Dissertation
Department (new version)
Public Health
Date of Award
1998
Degree Name by School
Doctor of Public Health (DrPH) School of Public Health
Abstract
Objective. To evaluate the relationship between relative and absolute income in the context of their respective influence on 10 measures of health status at the American county level. Setting. The 67 counties of the state of Alabama. Design. Cross-sectional ecological study. Relative income, i.e., income inequality, was indexed as the percentage of total household income received by the least well off 50% of households. Absolute income was indexed as the percentage of households below the federal poverty level. These two income measures, calculated for each county from 1990 census data, were used to specify and estimate a series of regression equations designed to compare their respective contributions to variations in health status across the counties. Results. Income inequality was significantly associated with differences in age-adjusted mortality, crude mortality, premature mortality, infant mortality, adult mortality (ages 35-64), and natural and external cause mortality, and with percentage of low weight births and percent of births to adolescents. In contrast to previous research, absolute income was also found to be a significant determinant of health status. Stratification of the counties into two groups based on the prevalence of household poverty significantly altered the importance of income inequality as a determinant of health status. For counties in which poverty was less prevalent, income inequality was more reliably associated with health outcomes. Conclusions. These data extend the scope of previous research in this area by demonstrating the presence of a deleterious impact of income inequality on health status at the American county level. They provide evidence that, although income inequality is a strong predictor of health outcomes, it is not a sufficient predictor. Instead, relative and absolute income function essentially as co-determiners of health status at the county level. This finding has interesting implications for previous research that proposed an "epidemiologic transition" in the course of economic development of populations, suggesting that such a transition may apply to developed as well as to developing countries. They suggest that health policies that address structural changes in the distribution of income may be more effective than those that focus on altering individual behavior.
ProQuest Publication Number
ProQuest ID
9910775
ISBN
978-0-599-08874-0
Recommended Citation
Rickert, Donna, "Income distribution and health outcomes: An assessment of the role of poverty" (1998). All ETDs from UAB. 7198.
https://digitalcommons.library.uab.edu/etd-collection/7198
Comments
DrPH