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Daniel S. Goldberg

Hi Bill,

Nice post. Stephen's paper was wonderful, but just to say that there is a debate about the very good question you ask (i.e., why it is that the increasing wealth of the most affluent would produce worse health for the bottom of the gradient).

The answer given by some is generally referred to as the relative income hypothesis. The idea here, which is hotly disputed, is that it isn't the concentration of wealth among the affluent by itself that matters, but the combination of that concentration with the stagnation of everyone else. This sounds like your position, but there's a subtle and important difference: the relative difference between the bottom, the middle, and the top of the social gradient is itself productive of poor health. Thus, it isn't simply absolute deprivation (i.e., stagnation on the bottom) that produces poor health, although even the most ardent proponents of the relative income hypothesis readily agree that it does.

Rather, because the rich are getting richer, the relative gaps between the poor and the rich increase, and it is the awareness of this increase (and its perceived unfairness) that produces poor health through a variety of mechanisms, including, perhaps most notably, violence (Richard Wilkinson has done the most work on this).

Anyway, that's the idea. Like I said - hotly disputed, although I agree with some commentators that the dispute itself is not really that consequential. No one denies that absolute deprivation matters, and even the so-called neo-materialists who are generally not big fans of the relative income hypothesis tend to admit that relative deprivation is morally and socially significant in its own right, and probably does have some effect on health (through diminution of social capital, for example). The argument seems to me to really be one of effect size, since the public policy intervention - redistribution of wealth -- seems to me to be recommended under either hypothesis.


Bill Gardner

Daniel -- great comment. Will respond soon, possibly in a follow-up post. Thanks.

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