2015

Income inequality – not just low wages – is taking a toll on the health of American workers


Linda Rosenstock co-wrote a commentary in the American Journal of Public Health underscoring the adverse impact of income inequality on health.

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“Income inequality” has already become a buzz phrase for the campaigns leading up to the 2016 elections. Likely candidates and pundits on both ends of the political spectrum have begun to talk about how fairness, social justice and — even after the implementation of the Affordable Care Act — the cost of health care insurance are contributing to the large and growing gap between the rich and poor.

But a commentary by researchers at the UCLA Fielding School of Public Health points out another disturbing impact of income inequality: its effect on people’s health. The article appears in the current online edition of the American Journal of Public Health.

It has long been recognized that, even beyond access to high quality health care, people’s income is a key factor in determining how healthy people are. But the commentary provides evidence that the degree of income inequality also can lead to a long list of health issues, including shortened life expectancy and poorer self-reported health status.

Dr. Linda Rosenstock, the report’s senior author, said lower- and sometimes middle-income wage workers often face additional workplace stresses that take a toll on their health — among them, lower pay, lack of paid sick leave, an inability to find full-time work, the need to work double shifts to make ends meet. Those challenges can lead to high levels of stress, exhaustion, cardiovascular disease, lower life expectancy and obesity, and the effects can easily trickle down to impact families and children.

“We interpret the evidence to find that income inequality is taking a toll on worker health,” said Rosenstock, a UCLA professor of Health Policy and Management and the former Dean of the Fielding School. “Low- and middle-income workers face stagnant wages and pressures from a changing work environment. These changes in the work environment changes — such as increasing job insecurity, work performed outside of a regular full-time contract, and having fewer workers to do the same amount of work — are taking their toll on a workforce.” 

The gap between the rich and the poor has expanded significantly since 1980, when the top 5 percent of wage earners accounted for almost 17 percent of all incomes, according to U.S. Census Bureau data. In 2013, that segment of the population earned 22 percent of total income. The changes were even more dramatic for those at the highest end of the income ladder, the top 1 percent and even the top one-tenth of a percent.

Another measure that reflects the divide between the economic elite and all others is the gap in pay between production workers and the CEOs of the companies they work for. In 1970, CEOs’ cash compensation averaged $25 for every $1 earned by nonsupervisory workers. Yet a mere 30 years later the ratio was 90 to 1, and, if the expected value of stock options in CEOs’ compensation is included, the ratio reaches more than 500 to 1.

“Out-of-pocket expenses for health care such as premiums, deductibles and co-payments are an increasing portion of stagnant wages,” Rosenstock said. She noted that one organization estimated that such costs increased by 89 percent from 2003 to 2013. “In 2013, among firms with at least 35 percent of their workforce making $23,000 or less per year, 48 percent of workers for single coverage had a deductible of at least $1,000 — a significant portion of their income.”

The commentary points to the health care industry — where there is a large disparity between the salaries for the lowest earners, such as nurses aides, and the top earners, such as surgeons — as one microcosm of the problems caused by inequality and changes in work organization.

“As the costs of medical care have risen in the United States, pressure on the industry has increased to improve efficiency,” said Jessica Allia Williams, PhD '13, the report’s first author and former FSPH doctoral student in health policy and management who is now a postdoctoral fellow at the Harvard School of Public Health.

As a result, she said, lower-paid workers face the perfect storm of income inequality — being asked to work more with less, while also paying more for insurance premiums and out-of-pocket medical expenses.

“Also, across the spectrum, health care workers face relatively high rates of injury owing to physical hazards such as lifting patients or getting stuck by needles,” Williams said, adding that they also are likely to work nonstandard shifts and more overtime and to face hazards such as violence in the workplace that further contribute to poor health.

Rosenstock said the effects of the Affordable Care Act on these trends are still unclear, especially because of the delay in implementing the employer mandate for health insurance. But despite the benefit of having more of the population insured, early evidence suggests that the ACA is causing lower-income workers to have to pay more of the costs of care out of their cash compensation.

“It’s clear that income inequality and working conditions affect the health of the U.S. workforce,” she said. “Although political differences may divide the policy approaches our elected officials may take, addressing income inequality is likely to improve the overall social and health well-being of those currently left behind.”

Read the Full Commentary

Faculty Referenced by this Article

Rosenstock
Linda Rosenstock
Environmental Health Sciences Health Policy and Management
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Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
Health Policy and Management
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Dr. Xi Zhu
Xi Zhu
Health Policy and Management
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Ty Robbins
Health Policy and Management
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Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
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Dr. Beth Glenn
Beth Glenn
Health Policy and Management
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Dr. Alice Kuo
Alice Kuo
Health Policy and Management
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Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
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David Hayes-Bautista
Health Policy and Management
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Freund, Deborah
Deborah Anne Freund
Health Policy and Management
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Comanor, Bill
William Comanor
Health Policy and Management
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Dr. William McCarthy
William J. McCarthy
Health Policy and Management
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Jean Balgrosky
Health Policy and Management
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Emily Abel
Emily Abel
Health Policy and Management
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Dr. Dylan Roby
Dylan Roby
Health Policy and Management
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Laura Erskine
Laura Erskine
Health Policy and Management
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Clifford Ko
Clifford Ko
Health Policy and Management
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Ron D. Hays
Ron D. Hays

@UCLA since 1997

Health Policy and Management
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Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
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Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
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Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
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James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
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Michael Ong
Michael Ong
Health Policy and Management
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Nadereh Pourat
Nadereh Pourat
Health Policy and Management
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Barbara Berman
Health Policy and Management
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Avram Kaplan
Avram Kaplan
Health Policy and Management
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Carol Mangione
Health Policy and Management
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Patricia Ganz
Patricia Ganz
Health Policy and Management
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Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
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Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
Health Policy and Management
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Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
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Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
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Leah Vriesman
Leah Vriesman
Health Policy and Management
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Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
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Dr. John Lu
Z. John Lu
Health Policy and Management
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Jack Needleman
Jack Needleman
Health Policy and Management
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Roshan Bastani Headshot
Roshan Bastani
Health Policy and Management
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Thomas Priselac
Health Policy and Management
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Burt Cowgill
Burt Cowgill
Health Policy and Management
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Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
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Mark Litwin
Health Policy and Management
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Alan Tomines
Health Policy and Management
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Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
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Vickie Mays
Vickie Mays
Health Policy and Management
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Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
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Moira Inkelas
Moira Inkelas
Health Policy and Management
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Diana Hilberman
Diana Hilberman
Health Policy and Management
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Steven Teutsch
Health Policy and Management
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Dr. Jennifer Wortham
Jennifer Wortham
Health Policy and Management
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Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
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Dr. Yvonne Flores
Yvonne Flores
Health Policy and Management
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Robert Brook
Health Policy and Management
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Susan Ettner
Health Policy and Management
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Gerald Kominski
Gerald Kominski
Health Policy and Management
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Neal Halfon
Health Policy and Management
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Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
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Dr. Kristen Choi
Kristen Choi
Health Policy and Management
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Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
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Emmeline Chuang
Health Policy and Management
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Warren Scott Comulada
Warren Scott Comulada
Health Policy and Management
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Thomas D. Gordon
Health Policy and Management
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Olivia Jung
Olivia Jung
Health Policy and Management
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Dr. Anthony Schiff
Anthony Hunter Schiff
Health Policy and Management
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Galper, Michael
Michael Galper
Health Policy and Management
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Jose J. Escarce
Health Policy and Management
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Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
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Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
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Brennan Spiegel
Health Policy and Management
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Lori Pelliccioni
Health Policy and Management
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Robert Kaplan
Robert Kaplan
Health Policy and Management
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Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
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Dr. Aria Fallah
Aria Fallah
Health Policy and Management
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Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
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Jeanne Miranda
Jeanne Miranda
Health Policy and Management
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Dr. Thomas Rice
Thomas Rice
Health Policy and Management
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Annette Maxwell
Health Policy and Management
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Paul Chung
Paul Chung
Health Policy and Management
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Pamela Davidson
Health Policy and Management
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Arlene Fink
Health Policy and Management
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Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
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Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
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Dr. Frederick Zimmerman
Frederick Zimmerman
Health Policy and Management
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Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
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