Intended for healthcare professionals

Education And Debate

Socioeconomic determinants of health : Health and social cohesion: why care about income inequality?

BMJ 1997; 314 doi: (Published 05 April 1997) Cite this as: BMJ 1997;314:1037
  1. Ichiro Kawachi (nhike{at}, assistant professora,
  2. Bruce P Kennedy, director of public health practiceb
  1. a Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
  2. b Department of Health Policy and Management, Harvard School of Public Health
  1. Correspondence to: Dr Kawachi


    Throughout the world, wealth and income are becoming more concentrated. Growing evidence suggests that the distribution of income–in addition to the absolute standard of living enjoyed by the poor–is a key determinant of population health. A large gap between rich people and poor people leads to higher mortality through the breakdown of social cohesion. The recent surge in income inequality in many countries has been accompanied by a marked increase in the residential concentration of poverty and affluence. Residential segregation diminishes the opportunities for social cohesion. Income inequality has spillover effects on society at large, including increased rates of crime and violence, impeded productivity and economic growth, and the impaired functioning of representative democracy. The extent of inequality in society is often a consequence of explicit policies and public choice. Reducing income inequality offers the prospect of greater social cohesiveness and better population health.

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