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LETTERS: Richard Wilkinson and Stephen Bezruchka Income inequality and population health BMJ 2002; 324: 978 [Full text]

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Measuring Income Inequality in the UK

Frank T Houghton   (20 June 2002)

Measuring Income Inequality in the UK 20 June 2002
Frank T Houghton, Health Geographer Department of Public Health, Mid-Western Health Board, Limerick, Ireland. Send response to journal: Re: Measuring Income Inequality in the UK	The income inequality hypothesis remains the subject of great debate. 1-2 Numerous studies have been published on this topic, many of which have reported differing results and suggested differing explanations for the observed relationship between income inequality and health. 3-7 Studies on this issue conducted in the USA and UK remain sharply divided in methodology over access to income data. This information is often accessible in the USA, but rarely so in UK studies. Although it is clear that income is only a proxy measure of social status, some standardisation of investigative techniques would obviously be advantageous. It seems unlikely that income data via the UK census will be delivered in the near future, plus the ten-year gap between each census severely constrains the accuracy of this information. However one potential avenue of investigation in obtaining income data may lie in accessing income information from the Inland Revenue. UK maps using information extracted from the annual reports of the Commissioners for Inland Revenue detailing wages, salaries and net incomes have been produced in the past. 8 It is interesting that in the context of income inequality, Rawstron & Coates mention that one area, Westmoreland, ‘was unique in having excessive numbers of incomes at the extremes, namely, over £1,500 and under £400’ (page 323). Attempts should be made to access and utilise this data in the future in the UK. Even if accessible, this dataset will have limitations. Historically this data referred only to place of work. This obviously raises issues relating to commuting patterns. Other potential issues relate to trying to establish household incomes, as well as the issues of fiscal honesty and tax evasion. Furthermore this aggregate data will only facilitate ecological, rather than multi-level analysis. However this data source still offers significant potential and needs to be explored in-depth. References 1. Mackenbach JP. Income inequality and population health. BMJ 2002; 324: 1-2. 2. Wilkinson RG, Bezruchka S. Income inequality and population health. BMJ 2002; 324: 978. 3. Coburn D. Income inequality, social cohesian and the health status of populations: the role of neo-liberalism. Soc Sci Med 2000; 51: 139-150. 4. Fiscella K, Franks P. Poverty or income inequality as predictor of mortality: Longitudinal cohort study. BMJ 1997; 314: 1724-1728. 5. Gravelle H. How much of the relation between population mortality and unequal distribution of income is a statistical artefact? BMJ 1998; 316: 382-385. 6. Daly MC, Duncan GJ, Kaplan GA, Lynch JW. Macro-to-micro links in the relation between income inequality and mortality. Milbank Q 1998; 76: 315- 339. 7. Kennedy BP, Kawachi I, Glass R, Prothow-Stith D. Income distribution, socio-economic status, and self rated health in the United States: Multilevel analysis. BMJ 1998; 317: 917-921. 8. Rawstron EM, Coates BE. Opportunity and affluence. In: Jones E, editor. Readings in Social Geography. London: Oxford University Press; 1975. p. 316-328.