Australasian Science: Australia's authority on science since 1938

The Rich Get Healthier

By Tim Olds

We’re getting healthier and living longer, but the rich more than the poor.

What would prefer: to get a rise of $50 per week when everyone else (for the same amount of work) gets $100, or that everyone gets $30 per week? Or would you prefer a world where you live an extra 5 years and everyone else lives an extra 10 years, or where everyone lives an extra 3 years?

It doesn’t really matter what you want, here’s what you’re getting, at least in Australia: everyone is getting healthier and living longer, but some are getting healthier faster, and the gap is increasing.

Or so a recent study from Sydney University tells us. In NSW in 2002, 55% of adults had a “high lifestyle risk”, defined as two or more of the following unhealthy behaviours: high alcohol consumption, physical inactivity, low fruit and vegetable intake, and smoking). By 2012 that was down to 45%. New South Welshfolk today are drinking less, smoking less, eating more fruit and veg, and getting more exercise.

So far, plain sailing. However, in the richest 20% of the NSW population, the improvement has been much greater: down from 46% unhealthy in 2002 to 35% in 2012. In the poorest 20% it only fell from 57% to 54%. The gap has increased: in 2002, there were 1.24 unhealthy poor people for every unhealthy rich person. Now there are 1.53.

An earlier study covering the period 1989–2001 found the same trends in Australian capital cities. Over that period, 3% of the poorest group gave up smoking compared with 5% of the richest. An extra 3% of the poorest group became sufficiently active, while 8% of the richest group started exercising.

So what’s driving increases in health inequalities? For some, the answer is clear. In their book The Spirit Level, David Wilkinson and Kate Pickett claim that physical and mental health are considerably worse in countries where inequality of wealth and income is greater, regardless of the overall level of wealth of the country. There is, they claim, something about inequality in itself that causes ill-health. Wilkinson and Pickett speculate that what’s causing this may be stress generated by comparison anxiety: stress levels increase when you see the Joneses are doing better than you. This generates an inflammatory response, and everything goes downhill from there. Equality keeps us on an even keel.

Wilkinson and Pickett’s argument has come in for some heavy-duty criticism: they have been accused of sins both agricultural (cherry-picking) and industrial (data mining). For example, South Korea and the Czech Republic have been mysteriously excluded from their datasets. They appear at times to be using some fairly dodgy estimates of inequality, and iffily confusing correlation with causation. A lot of their results also seem to be driven by the outlier Scandinavian countries (which are both very equal and very healthy).

Even if health inequalities are not being driven by income inequalities, they’re being driven by something. In Australia, at least, the rising tide is lifting some boats faster than others. But what if health is getting worse: do we get less inequality? Does a falling tide fall faster for the higher boats?

Surprisingly, the answer may be yes, at least in some countries. Consider obesity. Adults are still getting fatter pretty much around the world.

But is the gap in obesity increasing? Between 1995 and 2011, Scots as a whole got fatter but inequalities were reduced. In 1995, 16% of semi-skilled and unskilled Scottish workers were obese, and this had risen to 25% by 2011. In professional and managerial jobs, the rise has been from 16% to 30%. North of the border, fat cats are getting fatter faster than manual workers. The same appears to have happened in Canada between 2000 and 2010. In the US, the gap has been relatively stable since 1971.

Happily, what is true inside countries is not true across countries. Across countries, the gap is closing, largely because of the rapid modernisation of China and India, whose economies are going full steam ahead. In 1920, life expectancy at birth in China was 31. It is now 74. In India it was 29 in 1930, and is now 65. These are increases of 42 and 36 years. Over the same period, life expectancy in Australia increased from 65 to 82, an increase of just 17 years.

Does it matter? If we’re all getting healthier, surely that’s a good thing. I guess it depends on how you feel about everyone else getting that $100 while you only get $50. It depends on what floats your boat.

Professor Tim Olds leads the Health and Use of Time Group at the Sansom Institute for Health Research, University of South Australia.