The Link Between Health and Wealth

hans_roling_dataMy wife (a doctor) likes health, and I like money. In that sense, our marriage represents the intersection of two things everybody wants more of.

The biggest predictor of good health and a long life is how wealthy you are. This is often true – with plenty of variation of course – at the individual level. The correlation is even stronger at the societal level. Conversely, poverty in society correlates highly with illness and death.

To see the link between money and health most memorably, you really should look up – on your favorite video playback device like your iWatch (do those still exist?) – the YouTube videos of Hans Rosling.

Rosling, a Swedish data scientist, animates massive time series of national data sets that show the change in the life expectancy of people, as incomes rise, over time. In one short 4-minute video you can see where we humans were – grouped by country – in the year 1800. There’s a big clustering of national populations with an average lifespan of around 40 years in 1800. The year 1800 was only 150 years past Thomas Hobbes’ description in Leviathan of the life of man as “poor, nasty, brutish and short.”

Rosling then rolls the animation forward in time, and we see that as incomes rose over the past two centuries so did lifespans. First Europe and North America move upward in lifespan as incomes rise, but then eventually in the second half of the Twentieth Century huge populations in Asia and Africa rise in both average income and expected longevity.

It’s really much cooler to watch than it sounds. (Or maybe I need better hobbies? You tell me.)

The video is also a great reminder that no matter how much we may despair about the direction of the world on a day-to-day and week-to-week basis, on at least a decade-by-decade scale, we’ve made extraordinary strides as a species.

Most countries in the world – especially the rich ones – soar to above 75 years life expectancy by 2010. The wealthier we get, the longer we live. This is an extremely strong reason for optimism about the future. We have pulled ourselves up from the Hobbesian morass.

Hans Roling

For academic types and data nerds I’ll briefly acknowledge that the causal relationship between income and life expectancy is considered poorly understand by scholars. It’s a classic chicken and egg question – do you need wealth to become healthy or health to become wealthy? The relationship over time is so clear, however, that we can say this: We will live longer, if we can all figure out how to get richer.

Ok, that’s the happy story, and I think is a long-run optimistic thought.

Health and Wealth at Home

The glass is also only half full, however.

The link between wealth and health – or if you prefer that half-empty glass, the link between poverty and death – not only correlates over time, but also in specific locations.

In August of this year, my home city of San Antonio released its own powerful data visualization map showing the relationship between health and money for specific places at a moment in time.

The map shows color-coded average life expectancy in San Antonio zip codes, for which we also have average income data.

In zip codes directly East and West of my house, to examine some specifically poor neighborhoods, people have a life expectancy 15 years lower than people who live in the wealthiest zip codes of my city. 15 years on average! How big is that gap?

The 15 years on average difference between San Antonio zip codes is bigger than the difference between the average life expectancy in The United States (79.3 years) and Ethiopia (64.8 years), according to the World Health Organization. The health differences between neighborhoods in my city seem to me nasty and brutish. The disparity is an indictment of how wealthy – in the truest sense of the word – we really are today.

And while San Antonio just happens to be the most unequal city in the country by zipcode comparison, according to a report by the think tank Economic Innovation Group, this kind of health and wealth disparity is found all over. Fort Worth, TX ranks third in the nation in zipcode disparity. Houston’s Tarrant County ranks 12th among counties nationwide for zip code inequality.

Policy implication

The opening move of the Trump administration and the next Congress “on Day 1” will be the repeal of the Affordable Care Act (aka Obamacare.) This is just a current example of one policy issue at the intersection of health and wealth.

affordable_care_actPlease believe me when I say I’m agnostic overall about whether that’s a good or bad move, in the long run. Its repeal and/or replacement might lead to something better. I know more or less what ACA supporters intended, which was an attempt to blunt the effects of poverty on health outcomes. I know many intended beneficiaries found the rollout clumsy, coercive, and surprisingly expensive. I know many opponents feel socialized medicine like this makes us poorer.

The bigger question

That unhappiness with the ACA notwithstanding, the biggest question is not necessarily the ideal form of government-subsidized healthcare. That’s kind of a distraction, actually.

In my mind the central issue is whether poverty, and the faster death that comes with it, are ok.

Are we ok with this? Are we ok in the short run with a life-expectancy difference comparable to the gulf between the United States and Ethiopia? That gap exists between me and my neighbors just down the street.

I know what the long-term solution is at the intersection of health and wealth, and I’m really happy about that. It’s the short and medium term that we haven’t solved.


A version of this post ran in the San Antonio Express News and Houston Chronicle


Please see related posts:

The Map: Inequality in America – From the Washington Post

Kooky and Good Idea To Address Inequality

Book Review: Plutocrats by Chrystia Freeland

Video: Wealth Inequality in America



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