Members of PSR are well aware that excellent health care is only one factor in improving health outcomes.  The major determinants of health are the social and physical environments in which we live.  While we can improve the health of the communities in which we work clinically one patient at a time, we can also advocate for improvements in the social and physical environments that can result in advances in health for an entire community.

Public health researchers have now shown conclusively that rising income inequality results in social dysfunction leading to poor health outcomes.  Since the 1970s, wealth and income distribution in the United States has become increasingly unequal.  We are now the most unequal of all of the developed countries. The health indicators show that this trend has been disastrous.  Despite being the wealthiest country on earth, the United States does not place in the top twenty countries in life expectancy, infant mortality, child mortality, mental health, substance abuse, and obesity prevention. The generalized social dysfunction which accompanies rising inequality also results in low levels of trust, poor academic achievement by our children, high rates of teen pregnancy, high incarceration rates and low rates of social mobility based on merit.  We even recycle less than other wealthy countries.  Compounding this problem is the fact that rising income inequality in the United States is invisible to most people.

It hasn’t always been this way.  Franklin D. Roosevelt’s New Deal programs and the G.I. benefits that followed World War II made us the envy of the world.  The gap of inequality was not as large at that time, and our overall health statistics ranked us among the top nations. These advances were, however, largely denied to people of color and women. Since the 1970s and accelerating in the 1980s the United States has become more and more unequal. The causes for rising income inequality are largely political and well documented. Minimum wage laws have not kept pace with inflation or rises in productivity.  Laws and policies have significantly weakened labor unions.  Tax laws have failed to redress the increasing disparities in wealth and income. The resulting adverse health impacts from these political decisions will not easily be reversed without major changes in redistributing wealth and income from the very top of the socioeconomic pyramid to those at the base and middle. PSR can play a vital role in re-framing these discussions.  Rigid political ideologies like no tax increases for the ultra-wealthy will need to be replaced by a focus on practical programs and policies which advance population health and social well-being.