Economic stability is one of the five key social determinants of health (SDOH) and it significantly impacts health status. In the view of the 1795 Group, economic stability is the most important social determinant of health.
The conditions and environments in which people are born, grow, live, learn, work, play, worship, and age are called the social determinants of health (SDOH). These determinants of health are viewed as the “causes of the causes” of health because they have a stronger impact on health than any other factors.
Healthy People 2030 (the U.S. Government’s objectives to improve health and well-being of its citizens) identified five key social determinants of health: 1) Neighborhood and Built Environment, 2) Health Care Access and Quality, 3) Social and Community Context, 4) Education Access and Quality, and 5) Economic Stability.
Economic stability typically receives the least amount of attention from many experts, including the U.S. federal government. Yet this social determinant is the most powerful predictor of health.
Economic Stability Influences Many Factors
Socioeconomic factors are related to a wide range of health outcomes. Factors such as employment, income level, where one lives, quality of education, and access to reliable transportation significantly impact health.
For example, millions of Americans live in places with high levels of ozone or other air pollutants. In these locations, there is often a higher prevalence of asthma compared to state and national levels. Moreover, children born to parents who dropped out of high school are more likely to live in at-risk environments filled with barriers to good health (e.g., high crime, lack of safety, increased exposure to garbage, fewer sidewalks and parks, fewer green spaces, playgrounds, and libraries).
Wide Gaps in Economic Equity Increase Personal and Social Risks
Wide gaps in economic equity among people in any society are associated with increased risks of public health problems. Past research has reported that overall health tends to be worse among populations that live in more unequal societies where wide gaps in income exist.
A range of negative outcomes is associated with negative social gradients (i.e., gaps in social status). The greater the degree of economic inequity, the greater the negative outcomes.
For example, having secure, full-time employment that occurs in safe working conditions, in a healthy environment, which yields adequate income to meet one’s financial needs provides numerous benefits that contribute to positive health. Good paying, secure and safe jobs make it easier for workers to live in healthier, safer neighborhoods, provide quality education for their children, secure good quality child care services, buy more nutritious foods, and have good health insurance coverage and retirement benefits
In contrast, those who face job insecurity or unemployment report higher rates of obesity, smoking every day, sleeping less than six hours/day, missing work, and a worsening general health status. Furthermore, those who report higher rates of job insecurity are five times more likely than those with low job insecurity to report serious mental illness within the past 30 days, headaches, neck pain, low back pain, ulcers, diabetes, hypertension, and coronary heart disease. Similarly, the Bureau of Labor Statistics reported that workers who are laid off from their jobs were 54% more likely to have fair or poor health status compared to those that are continuously employed
Under-Employment or Unemployment
According to U.S. Census data, over time, the unemployment rate for people of color has been consistently higher than among whites, by roughly 5 percentage points. Those who are unemployed or underemployed are also more likely to face food insecurity.
In 2016, the USDA estimated that 12% of U.S. households were “food insecure.” Now, due to a lack of financial resources, 34 million Americans live in households that struggle with a lack of food or lack of access to an affordable, nutritious diet. Those households are typically those with incomes near or below the federal poverty line.
The Rich Keep Getting Richer and the Poor Keep Getting Poorer
Prior to the COVID-19 pandemic in the U.S., there was wide economic disparity between the “haves” and the “have nots.” The pandemic may have caused the gap to increase.
This gap has been growing over time as the share of total societal wealth continues to be concentrated among the few. For example, in 1989, the top 1% of the wealthy in the U.S. held 30% of the total societal wealth. By 2016, the top 1% of the wealthy in the U.S. held 40% of total societal wealth. In 2020, this increased to 66% of societal wealth controlled by the richest 1%. Is having increasing more societal wealth controlled by just a few people healthy for any society?
If we look at the gap in income between groups, the differences are even starker: By 2015, the top 1% of wealthy families made more than 25 times what families in the bottom 99% made. By 2017, this had increased to 39 times more than what the bottom 99% made. By 2022, the top 1% of the wealthy made 142 times more than the bottom 99%. Is this healthy for any society?
Billionaires have seen extraordinary increases in their wealth recently. During the COVID-19 pandemic and the cost-of-living crisis years since 2020, a total of $26 trillion (63%) of all new wealth was captured by the top 1%, while $16 trillion (1%) went to the rest of the world!
Billionaires gained roughly $1.7 million for every $1 of new global wealth earned by a person in the bottom 90 percent. Billionaire fortunes have increased by $2.7 billion a day. This comes on top of a decade of historic gains. Over the past ten years, the number and wealth of billionaires doubled.
The Huge Chasm in Economic Equity Did Not Always Exist
The current chasm economic equity between the “haves” and the “have nots” has not always existed. Between the 1940’s and late 1960’s in the U.S., income grew rapidly and randomly among the wealthy and poor These years featured substantial economic growth and broadly shared prosperity among all sectors of American society. During this time period, the incomes of all wages earners (i.e., low, middle, and high) grew rapidly at about the same rate, roughly doubling in inflation-adjusted terms.
However, in the late 1970’s, things began to change. Economic growth slowed and the income gap widened. Income growth for households in the middle and lower classes slowed while incomes at the top continued to grow.
This is clearly evidence by these statistics: Between 1979 and 2017 (38 years), the bottom 90% of U.S. population saw a modest increase (22%) in their average income. In contrast, during the past 50 years, the income for the top 1% of Americans doubled.
These changes are also corroborated by where people lived. In 1980, 12% of the American population was living in designated places for the rich or poor. However, by 2013, this percentage jumped by 2.5 times to 30%. This stark geographic segregation by wealth is not healthy for any society.
Less Purchasing Power Among Middle-Class Families
According to research from Pew, the middle class, once clear majority in America, has steadily contracted in the past five decades. The share of adults who live in middle-class households fell from 61% in 1971 to 50% in 2021.
The shrinking middle class has been accompanied by an increase in the share of adults in the upper-income tier – from 14% in 1971 to 21% in 2021 – as well as an increase in the share who are in the lower-income tier, from 25% to 29%.
As a result of these factors and rising costs of living, middle-class families have far less purchasing power today than in the past. Today, the average middle-class paycheck has the same purchasing power that it did 40 years ago. As income growth slowed for the middle class, the costs of living (e.g., utilities, gasoline, food, prescription drugs, medical care, and insurance) continued to increase. Put simply, average wages of the middle class have not kept up with increasing costs.
The “Haves” and the “Have Nots”
Since the 1970’s, economic inequity in the U.S. between the “haves” and the “have nots” has widened as societal wealth has been increasingly concentrated among the top few. Today, the top 0.1% of the wealthy take in 188 times more than the bottom 90% of the U.S. population. The increasing consolidation of wealth among a few and the growing number of “have nots” is not sustainable and significantly increases the risks for U.S. society.
As I write this blog, automotive workers affiliated with the UAW are on strike. For what causes are they striking? Let me give you an example: In 2022, Mary Barra, the CEO of General Motors made just under $29,000,000. In case math is not your strength that is $29 million.
In stark contrast, as of September 22, 2023, the average hourly pay for a worker at the GM Plant in Michigan was $17.71 an hour. Some worker’s salaries were as low as $11.79 per hour. Using $17.71 per hour x 50 hours per week x 49 weeks (3-weeks of vacation), equals $43,390.
What is the difference between $29 million and $43k per year? If I did my math correctly, the difference between the annual salary of the CEO at GM and the average production worker at GM is 674 times. Yes, you read that correctly: 674 times greater. Seem fair to you?
Why Economic Equity Matters
The rise in economic inequality in the U.S. is tied to several factors. These include, in no particular order, the eroding value of the minimum wage, technological change, globalization, the decline of labor unions. Besides the health problems and increased risk of societal upheaval caused by increasing economic inequality, the uninterrupted increase in economic inequality since the late 1970’s has become a major concern among members of the public, researchers, public health experts, policymakers and politicians.
One reason for this concern is that the “have nots” may experience diminished economic opportunity and mobility in the face of rising inequality, a phenomenon referred to as The Great Gatsby Curve. Others have highlighted inequality’s negative impact on health, political influence, geographic segregation by income, lack of investment in certain neighborhoods, and on economic growth itself.
A Disaster in the Making
In the opinion of the 1795 Group, the growing economic divide between the few and the many is a disaster in the making. It is our belief that American society is already in the intensive care unit on mechanical ventilation. If economic inequity is not addressed, we believe that the U.S. will experience more picketing, more strikes, more protests, stronger calls for change, and stronger action.
Lack of employment, food, housing, health care, and increasing economic burdens among the “have nots” will likely boil over into frustration, anger, and action. Hopefully that action will be positive, constructive action within our system of government.
You Can Help
This widening gap needs to be closed. Listed below are ten things that you can do to help:
- Vote: Put politicians that care about economic inequity and are willing to do something about it in office and vote out those who do not. Look at their track records. What have they done? What legislation have the sponsored? For what causes have they voted?
- Raise Equity Conscious Children: We can read all the books and go to all the classes, but in the end, it comes down to one question: Are we being the adults that we want our children to grow up to be? Who we are and what our behaviors reveal are strong predictors of who our children will be and what they will believe about themselves and the world. The way to raise equity-conscious children is to model equity-conscious behaviors. Do you? Do you point out inequity in the world and in your own lives? Equity consciousness requires deep reflection and learning.
- Advocate for the Creation Universal Pre-K: Join the 1795 Group in advocating for this. High-quality preschools give families options. Universal means every young child gets the opportunity to thrive. Universal means that no parent has to choose between working to earn money for housing and food or paying for childcare and education. Universal Pre-Ks help kids to be successful. Universal Pre-K boosts every sector of the economy. In contrast, being unable to send children to preschool forces women out of the workforce and has a negative impact on Black, brown and low-income children.
- Volunteer to Help Urban Kids Read: Did you know that a child’s 3rd grade reading level is highly predictive of whether he/she will graduate from high school, enroll in a college of job training program, graduate, and ultimately be successful? Call your local school system and volunteer!
- Integrate Schools: In the preamble to its constitution, the World Health Organization says that health is a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity.” However, this is not the state of health for students who attend segregated schools. Put simply: racial segregation is unhealthy. Structural racism a public health crisis – one that impacts many children in the institutions where they spend much of their time: schools. Segregated, unequal and underfunded schools, and the education received in them, constitutes a hidden form of structural or institutional racism that, over time, harms people. The impacts are educational, but also psychological, emotional, spiritual and physical. Letting underfunded schools linger for years clearly shows our children that they are less important than others.
- Advocate for Universal Health Care: Did you know the United States is the ONLY country in the world that does not have universal health care for all? Why not? We have the most expensive health care system in the world and some of the worst outcomes. Currently, about 27 million Americans of all ages do not have any health insurance. Zero. Join the 1795 Group in advocating for universal health care for all.
- Pay Workers a Livable Wage: About 10% of the American work force is working multiple jobs to pay the bills. Even as workers have been more industrious helping drive up corporate profits, the stock market, and CEO compensation to record heights, their pay flat-lined or even declined when factoring in inflation. If the minimum wage had kept pace with gains in the economy’s productivity over the last 50 years, it would be nearly $26 an hour today, or more than $50,000 a year in annual income. Let’s pay workers a livable wage.
- Invest in Environmental Hazards and Protect the Most Vulnerable: The 1795 Group is very concerned about the quality and safety of our water, air, food, and household products. Join us in advocating for a safe and healthy environment. Across the U.S., many people face environmental hazards that threaten their health. These environmental hazards have disproportionately burdened communities of color. Rooting out the systemic forces (e.g., historical redlining) that have led to this disparity will be complicated. However, something needs to be done now.
- Reform Tax Breaks for Pass-Through Businesses: A closer look at the composition of U.S. wealth helps us understand this one. Many of America’s ultra-wealthy are private business owners benefiting from tax benefits to pass-through business owners. Thus, reforms to overhaul tax breaks to pass-through businesses as well as efforts to repair tax enforcement weaknesses related to private businesses, and related loopholes, would increase tax income substantially. Recent estimates of the tax rates that businesses pay show that “pass-throughs” pay historically low effective tax rates.
- Reform the Tax Laws: Reforms that focus on payments to owners of businesses—the corporate tax, the dividend tax, and capital gains tax—are likely to help. The largest component of wealth of the richest Americans is “C-corporation equity wealth.” Effective tax rates for each of these taxes have fallen substantially in recent decades. Reverting back to the tax code of 1997 would raise substantial tax revenue. In addition, higher corporate tax rates and minimum taxes would likely increase tax payments from the wealthiest of Americans who should be paying for needed programs and services.
The 1795 Group Can Help
We care a lot about the world that we will leave for those who will follow in our footsteps. We want this little blue planet to be a better place for all who live on it. That’s why we do what we do. We believe in being part of solutions. Let’s work together.
Perhaps you would like a guest speaker or a presentation on this topic. Perhaps you would like to have your students, learners, or employees enjoy an in-person or virtual professional development workshop in this topical area. Perhaps you need a course to be written for your learners. Whatever your need, the 1795 Group can help. Call us and let’s brainstorm ways to work together.
Contact me today:
Phone: (419) 359- 5798 (text first)