Income Inequality
I’m worried. Income inequality and its consequences are worsening in Maine and across the world. My colleagues and I demonstrated that phenomenon recently in our published lead article about Franklin County in the Journal of the American Medical Association. There we showed the very strong correlations of Maine counties’ household income with age-adjusted mortality. Franklin, where we implemented multiple programs to improve health, did as well as Cumberland and other affluent communities; and it was one of only 17 counties in the US that lower mortality than predicted by income. So we conclude that, unless there are concerted efforts to improve access and reduce risk factors like hypertension and high cholesterol, smoking and inactivity, people living in the vast majority of low income US counties, die at significantly higher rates than their more affluent peers.
In addition, over the 50 years we studied, the degree to which income explained county mortality differences in Maine increased from 14% in the 1960s, to 38% during 1970-1990, and finally to 81% from 1990-2010! In other words, now 81% of the mortality differences among counties can be explained by the average household income in each county. That is a dramatic increase over 50 years.
Yet another finding in our paper about Maine counties, was that from 1960 to 1990, county household income varied only about $15,000/yr between the most and least affluent counties. However, from 1990-2010, that difference increased to $20,000 (Fig 5 in our paper). And finally, both Franklin and Kennebec counties became poorer relative to the rest of Maine; Franklin went from 5th most affluent down to 11th, while Kennebec moved from 2nd down to 6th most affluent.
So right here in Kennebec and Franklin counties, we observed fairly rapidly increasing income disparity over the past 50 years. Since we know from our study and others that lower incomes correlate with poorer health and mortality, this is not good from a humanitarian view as well as an economic one. We demonstrate in our Franklin County study that, along with fewer deaths, the interventions were associated with substantial cost savings in hospitalization costs alone, about $5.5 million/yr.
And just recently (Jan 24), the Kennebec Journal editorialized about the need for aggressive public school actions to counteract the educational impairments created by poverty because now more than half their students are from low-income households.
Access to health care is crucial to disease prevention; for instance, physicians or other clinicians must be available to start and supervise medication use for hypertension, high cholesterol, and smoking cessation. Recent actions by the current state administration are now taking us in exactly the wrong directions. The tobacco settlement monies, previously directed by Gov Angus King to statewide multiple smoking cessation programs modeled on the Franklin Co successful experience, are being cut and redirected elsewhere. Medicaid (MaineCare) expansion of health care coverage for the mostly working poor through the federally subsidized Affordable Care Act continues to be rejected. And where are the expanding pre-K and other educational interventions?
I despair. Someone please give me hope that we can reverse these trends, educate our children, high and low income together, and work strenuously again to prevent disability and disease, as we have showed we can. By doing so, we could save medical costs, create a healthier stronger, smarter workforce, which can better care for our increasingly elderly state. Or are we to take the Dickensian Scrooge approach to the poor: “let them die and decrease the surplus population”.
Daniel K. Onion, MD, MPH
Mt. Vernon/Vienna Health Officer
293-2076
1/25/15