Income and Wealth

Question 1

what does it mean that “health is not randomly distributed”

Answer 1

• the idea that people’s health status is not determined by chance, but rather by various factors like SES, access to healthcare, lifestyle choices, environment, and genetics
• these factors contribute to a patterned distribution of health outcomes, meaning certain populations experience significantly better or worse health than others.

Question 2

what is the difference between wealth and income?

Answer 2

• wealth = the monetary value of all possessions and assets accumulated by a person or family over time
• income = earnings over a specific time period

Question 3

is income or wealth a better measurement?

Answer 3

• income is a less comprehensive representation of the economic resources available to a person/household
• income fluctuates so it only provides limited information about economic advantage or disadvantage that could influence a persons health
• classifying on income alone may provide a misleading picture of their economic resources!

however, wealth is harder to measure because it is hard to approximate without respondents accessing personal records (which can be seen as intrusive)

Question 4

what is the distribution of income and wealth?

Answer 4

the gap between the wealthy and the poor is increasing!!
- while the shifts in overall distributions of income and wealth have increased, disparities between income and wealth when comparing subgroups defined by populations (i.e race, ethnicity, gender, disability, age) are even more significant

Question 5

what is upward mobility?

Answer 5

• the ability to move up in socioeconomic status, such as by changing jobs, earning more money, or improving living conditions
• can also refer to an employee’s ability to advance to a higher position within a company

Question 6

what is the black/white wealth gap?

Answer 6

• refers to the disparities in wealth and income when comparing African Americans to White people
• White people make far more $$$$ than African Americans
• the black/white wealth gap begins early in life and widens as people age
• this suggests that black people are more likely to be born into disadvantage and more likely to face barriers to home ownership, stable employment, and other opportunities associated with building wealth over a life time

Question 7

what are the reasons for income and wealth gap?

Answer 7

wealth inequities persist largely due to systemic and structural racism
1) racial residential segregation
2) employment discrimination in hiring, pay and promotion
3) discriminatory policing and sentencing practices

Question 8

how does racial residential segregation impact wealth?

Answer 8

• segregated urban neighbourhoods and Indian reserves are more likely to have concentrated poverty and limited access for upward mobility due to lack of good land, school, jobs and services
• redlining has lead to disparities in home ownership, home value and credit scores in original redlined communities are still apparent today

Question 9

what is redlining?

Answer 9

• refers to the practice of banks drawing red lines on maps around urban neighbourhoods where people of colour reside
• redlining was used to define where loans would and would not be given to purchase homes or start businesses

Question 10

how does employment discrimination impact wealth?

Answer 10

• racial discrimination in hiring, pay and promotion impacts ability to accumulate income and wealth (mostly due to implicit bias)
• people of colour are targeted by predatory financial services such as pay-day lenders, check-cashing services and pawnshops, and they tend to charge excessive fees/interest rates

Question 11

how does discriminatory policing and sentencing impact wealth?

Answer 11

• black people are overrepresented in Canada’s criminal justice system
• a history of incarceration permanently stigmatizes young people, impacting opportunities of employment and economic success

Question 12

how has the shift from a manufacturing to knowledge economy impacted the income/wage gap?

Answer 12

• over the last 5 years the focus of the economy has shifted from manufacturing to knowledge
  –> manufacturing jobs have moved to jurisdictions where costs are cheaper
  –> focus of economy is now on technology, healthcare, innovation, energy, tourism/service
  –> this shift requires a need for higher education, therefore it is difficult to survive without education/credentials

Question 13

what 3 factors can interplay with income and wealth

Answer 13

• gender
• disability status
• age

Question 14

how does gender influence income and wealth?

Answer 14

despite increasingly more women joining the workforce, gender-based disparities in pay and advancement persist = impacts opportunities to generate wealth and build income
- women of colour face compounded disadvantages based on gender and race
- women do most caregiving, reducing paid work hours and job related pensions/retirement account

Question 15

how does disability influence income and wealth?

Answer 15

people with disabilities face obstacles to earning income and building wealth
- the type and severity of disability and workplace accessibility impact an individuals capacity to participate in the workforce
- disabled people are less likely to have a bank account to build credit and savings
- healthcare-related costs, such as medications and supports, are costly

Question 16

how does age influence income and wealth?

Answer 16

• wealth disparities across age groups have widened over past 25 years
• older individuals are favoured to have more wealth than younger people

Question 17

what is intersectionality?

Answer 17

when individuals face multiple disadvantages (ex: black women) that shape their experiences
–> are not simply additive, but interact synergistixally

Question 18

how does low-income and early life experiences affect health?

Answer 18

the effects of income on health begin early in life:
- children from lower-income households experience more negative health outcomes
- parental wealth impacts children’s future health by influencing conditions during critical developmental periods

Question 19

how is economic inequality associated with population health?

Answer 19

there is an association between a society’s overall health and extent of economic inequality
- it is measure by the gini coefficient

greater economic inequality is linked to:
- poorer health outcomes
- reduced social cohesion
- lower public investment in health

countries with more equal wealth distribution have better health outcomes and less disease burden

*it is not overall levels of wealth in a country that matter, but also how wealth is distributed within a population

Question 20

what is the gini coefficient?

Answer 20

• a measure of how equally or unequally wealth is distributed within a countries population
• ranges from 0-1

0 = perfect equality and everyone has the same amount of resources
1 = the most unequal and all economic resources are held by one individual

Question 21

what is the relationship between health and income?

Answer 21

• higher income = longer life expectancy (for men and women)
• the greater a families income = the healthier the adults are (decreased presence of chronic conditions)
• decreasing economic resources of a household is associated with increased adverse childhood experiences

Question 22

how are economic resources associated with health outcomes?

Answer 22

higher income correlates with:
- longer life expectancy
- lower rates of chronic disease
- better overall health

as a result, wealth provides a buffer against financial instability, mitigating (reducing) stress-related health risks

for example: families in upper/middle class have money to take vacation, live in nice neighbourhoods, go to nice schools to buffer stress of everyday life!

Question 23

in what ways does economic resources influence health at an individual level?

Answer 23

• access to health-promoting goods and services
• psychosocial benefits
• cumulative effects of economic resources over a lifetime

Question 24

how does income impact access to health promoting goods and services?

Answer 24

• higher income/wealth makes it easier to pay for medical expensese and insurance (deductible, copayments)
• more economic resources increase access to material conditions that prevent getting sick in the first place (housing, food, activities)
• wealth protects against adverse consequences of job loss

Question 25

how does income affect psychosocial wellbeing?

Answer 25

- persistent stress can trigger long-term cortisol release into the blood stream which damages organs and organ systems in the body (inflammation and immune system dysregulation) - higher income/wealth can protect individuals and families from the stress associated with financial hardship - higher income/wealth helps improve access to activities and social networks (clubs, sports teams, recreational facilities) - perceived social status and how one views themself is tied to health

Question 26

how does wealth impact access to healthcare?

Answer 26

greater wealth helps facilitate access to: - healthcare services (routine check-ups and specialized treatments) - private health insurance/dental care - prevents debt-related health compromises (those with less $$ may delay or avoid treatment due to cost)

Question 27

how does wealth impact living conditions?

Answer 27

greater wealth means: - safer homes and better quality - fewer environmental hazards - access to nutritious food and physical activity - reduced neighbourhood violence and reduced overcrowding

Question 28

what are the psychosocial benefits of wealth?

Answer 28

- reduces life stressors - protection from chronic stress (wealth acts as a buffer) - enhances social cohesion and fosters social networks (involvement in sports, social clubs)

Question 29

how does intergenerational wealth affect education and health?

Answer 29

- parental income impacts the contexts that children grow up in, access resources and developmental stimulation they're provided - intergenerational positively influences health trajectories (can invest in preventative care, healthy living environments, other health practitioners) - intergenerational wealth provides future generation with better educational opportunities (better schools, tutoring etc)

Question 30

what did the study on low-income families and childhood development find?

Answer 30

the study found that children of low-income families have lower surface area in their brain compared to children of higher-income families - income differences in brain development may reflect the fact that poorer families are less able to provide children with cognitive stimulation, enriching experiences and help with homework - economically secure parents are more likely to provide better opportunities for development therefore, income-related differences in cognitive stimulation that parents an provide impact academic achievements, educational attainment, future employment and income

Question 31

what are some ways that parental income influences the health of their children?

Answer 31

- able to provide healthier living conditions for their kid - increased stimulation and support for their child - more likely to get higher quality education and support = better job opportuntieis - increased likelihood of the child inheriting their parents wealth

Question 32

what are epigenetic effects?

Answer 32

- refers to the bodily processes that do not change one's genetic makeup but have powerful effects on whether any given give is expressed ("turned on") or suppressed ("turned off") - are the result of interactions between one's genes and their social or physical environment

Question 33

what are some examples of interventions aimed at addressing income/health disparities?

Answer 33

- financial education - subsidized saving accounts - job training - rental and home buyer assistance - micro loans - increase availability to financial services

Question 34

what is required in order to reduce income-health dispairites within society?

Answer 34

in order to ensure that everyone has equitable opportunities to acquire and build wealth, changes at systemic and political level are needed! --> interventions within multiple sectors --> addressing just one this is NOT effective

Question 35

what is the health-income gradient?

Answer 35

- the systematic relationship between income and health - the idea that with every increase (or decrease) in income level at population level, we see a corresponding shift in health outcomes and life expectancy - health improves as income rises!!!

Question 36

why does the health-income gradient exist?

Answer 36

1) material factors - access to nutricious foods - safe housing - access to healthcare 2) psychosocial factors - stress from financial insecurity and job strain - lower sense of control - social support 3) behavioural factors - differences in lifestyle choices (i.e smoking, exercise)

Question 37

what are the Whitehall studies?

Answer 37

- a series of studies conducted on British civil servants --> Whitehall I (1967) = focused on men only --> Whitehall II (1985) = included men and women

Question 38

what was the objective of the Whitehall studies?

Answer 38

to investigate the relationship between socioeconomic status (SES) and health outcomes

Question 39

what were the key findings of the Whitehall studies?

Answer 39

- lower SES is associated with worse health outcomes - every employment grade from top (more $$) to bottom (less $$) was associated with a change in health status - risk factors are more common amongst lower paid, lower status employees - chronic stress and lack of control at work are significant contributors - smoking, diet, physical activity and biological markers (blood pressure, cholesterol) mediate health disparities - individual risk factors (smoking, blood pressure) does not account for differences in health status across grades

Question 40

how is wealth/income related to areas of health?

Answer 40

- the self-rated mental health gap by income as widened overtime (low income = worsened mental health) - poorer households report a higher percentage of having multiple chronic conditions - those with lower income are less likely to follow up with their doctor after leaving the hospital for mental illness or addiction

Question 41

what are the characteristics of health regions with lower life expectancies?

Answer 41

- higher levels of long-term unemployment - lower proportions of high school and university graduates - smaller immigrant populations - larger indigneous populations - rural/remote locations - highest rates of smoking, obesity and heavy drinking

Question 42

why is smoking, obesity and drinking associated with poor health?

Answer 42

- smoking is a risk factor for lung cancer, heart disease and stroke - obesity is linked to chronic disease and hypertension, such as T2D, CVD and hypertension - heavy drinking is associated with health problems like cirrhosis, heart disease, depression and social consequences (traffic accidents, lower productivity, violence)

Question 43

what is the significance of toronto?

Answer 43

- Toronto is the world's most economically powerful cities - it is one of the fastest growing G7 financial centre

Question 44

what are "The Three Cities Within Toronto"?

Answer 44

it describes the income polarization among different groups within Toronto from 1970-2005 1) city #1 - a predominately high income neighbourhood - generally located in central city and close to city subway lines - average income has risen significantly relative to rest of city 2) city #2 - mainly middle-income area - average income has remained fairly close to the city average 3) city #3 - generally low income - are generally located in the northeastern and northwestern parts of the city - average income has fallen substantially over the past few decades compared to the average

Question 45

why is Toronto referred to as the "city of disparities"?

Answer 45

- toronto is becoming increasingly divided by income and socioeconomic status - toronto is so polarized that is could be described as 3 geographically distinct "cities" - no longer referred to as "city of neighbourhoods" --> "city of disparities" * this three-city disparity did not exist before!!! *

Question 46

how has toronto changed from 1970 to 2000?

Answer 46

- the middle-class is shrinking - the rich got richer - the poor got poorer

Question 47

how does mortality relate to wealth in Toronto?

Answer 47

there may be a correlation between mortality rates and income distribution - lower income areas of Toronto coincide with regions with higher mortality rates (U shape around Yonge street) - in fact, life expectancy varies by almost 12 years across Toronto neighbourhoods - may be due to access to health, housing quality, environmental factors etc

Question 48

how do health outcomes from the lowest-income group compare to the highest income group?

Answer 48

- men are 50% more likely to die before age 75 - women are 85% more likely to have diabetes - young women are twice as likely to be reported with chlaymydia - babies are 40% more likely to be born with low birth weight

Question 49

what did the Wilkinson research study argue?

Answer 49

- he argued that its not just absolute income that matters, but rather how income is distributed in a society - this means that the relative position of individuals on the income ladder significantly impacts health outcomes

Question 50

what is the Wilkinson hypothesis?

Answer 50

- income inequality and health are negatively related to each other - in developed economies, individual income isn't the main determining factor of health but rather the degree of income inequality within a society!!!

Question 51

based on the Wilkinson study, what happens when the gap grows between high-income and low-income groups?

Answer 51

as income and education gaps between rich and poor grow, we will find: - lower societal levels of trust and mutual support - lower levels of civic engagement and cooperation - higher rates of violent crime - increased incidence of racism, discrimination and social exclusion - growth of hostile, marginalized sub-cultures --> therefore, lower health status overall (with adverse effects concentrated for people at or near the bottom)

Question 52

what are the components of the Wilkinson synthesis?

Answer 52

1) social capital theory 2) sociology and criminology 3) primatology

Question 53

what is the social capital theory of the Wilkinson Synthesis?

Answer 53

- Robert Putnams argued that more equal societies have greater levels of solidarity, social support, trust and mutual assistance

Question 54

what is the sociology and criminology component of the Wilkinson Synthesis?

Answer 54

- Durkheim claimed that social change is a major cause of stress, social dislocation, and dysfunctional behaviour - societies that are too diverse and undergoing rapid change destabilize their populations

Question 55

what is the primatology component of of the Wilkinson Synthesis?

Answer 55

- the study of monkeys, baboons, and chimpanzees, all of which live in social hierarchies, shows that subordinate animals die prematurely, mainly of stress, elevated levels of cortisol, and an associated unhealthy inflammatory response - animals whose position in the hierarchy improves show improved health and vice versa

Question 56

what are the main conclusions between health and wealth?

Answer 56

- the Whitehall Studies provide critical evidence linking SES to health outcomes. - the health-income gradient demonstrates that health disparities are systemic and require multi-level interventions. *key message = addressing socioeconomic inequalities is essential to improving public health