The New Palgrave Dictionary of Economics

2018 Edition
| Editors: Macmillan Publishers Ltd

Health Outcomes (Economic Determinants)

  • Christopher J. Ruhm
Reference work entry


This article summarizes the conclusions of research examining how health is affected by income inequality and temporary changes in macroeconomic conditions. In both cases, recent analyses have raised serious doubt about the ‘conventional wisdom’ derived from earlier studies using less adequate analytical methods. Specifically, the latest studies question the hypothesis that inequality has a large independent effect on population health, and suggest that economic downturns improve rather than worsen physical well-being.


Absolute income hypothesis Counter-cyclical Fixed effects Health outcomes Income inequality hypothesis Inequality of income Life expectancy Macroeconomic conditions Morbidity Mortality Pro-cyclical Relative income hypothesis Unemployment 

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  1. Brenner, M.H. 1979. Mortality and the national economy. The Lancet 314: 568–573.CrossRefGoogle Scholar
  2. Brenner, M.H., and A. Mooney. 1983. Unemployment and health in the context of economic change. Social Science Medicine 17: 1125–1138.CrossRefGoogle Scholar
  3. Deaton, A. 2003. Health, inequality and economic development. Journal of Economic Literature 41: 113–158.CrossRefGoogle Scholar
  4. Deaton, A., and D. Lubotsky. 2003. Mortality, inequality and race in American cities and states. Social Science and Medicine 56: 1139–1153.CrossRefGoogle Scholar
  5. Eibner, C., and W.N. Evans. 2005. Relative deprivation, poor health habits, and mortality. Journal of Human Resources 40: 591–620.CrossRefGoogle Scholar
  6. Eyer, J. 1977. Prosperity as a cause of death. International Journal of Health Services 7: 125–150.CrossRefGoogle Scholar
  7. Fiscella, K., and P. Franks. 1997. Poverty or income inequality as predictor of mortality: Longitudinal cohort study. British Medical Journal 314: 1724–1727.CrossRefGoogle Scholar
  8. Gravelle, H. 1998. How much of the relationship between population mortality and unequal distribution of income is a statistical artifact? British Medical Journal 316: 382–385.CrossRefGoogle Scholar
  9. Judge, K., J.A. Mulligan, and M. Benzeval. 1998. Income inequality and population health. Social Science and Medicine 45: 567–579.CrossRefGoogle Scholar
  10. Kasl, S.V. 1979. Mortality and the business cycle: Some questions about research strategies when utilizing macro-social and ecological data. American Journal of Public Health 69: 784–788.CrossRefGoogle Scholar
  11. Lynch, J., G.D. Smith, S. Harper, M. Hillemeier, N. Ross, G.A. Kaplan, and M. Wolfson. 2004. Is income inequality a determinant of population health? Part 1. A systematic review of the literature. Milbank Quarterly 82: 5–99.CrossRefGoogle Scholar
  12. McAvinchey, I.D. 1988. A comparison of unemployment, income and mortality interaction for five European countries. Applied Economics 20: 453–471.CrossRefGoogle Scholar
  13. Mellor, J.M., and J. Milyo. 2002. Income inequality and health status in the United States: Evidence from the current population survey. Journal of Human Resources 37: 510–539.CrossRefGoogle Scholar
  14. Neumayer, E. 2004. Recessions lower (some) mortality rates. Social Science & Medicine 58: 1037–1047.CrossRefGoogle Scholar
  15. Ogburn, W.F., and D.S. Thomas. 1922. The influence of the business cycle on certain social conditions. Journal of the American Statistical Association 18: 324–340.CrossRefGoogle Scholar
  16. Preston, S.H. 1975. The changing relationship between mortality and the level of development. Population Studies 29: 249–257.CrossRefGoogle Scholar
  17. Ruhm, C.J. 2000. Are recessions good for your health? Quarterly Journal of Economics 115: 617–650.CrossRefGoogle Scholar
  18. Ruhm, C.J. 2003. Good times make you sick. Journal of Health Economics 22: 637–658.CrossRefGoogle Scholar
  19. Ruhm, C.J. 2006. Macroeconomic conditions, health and mortality. In Elgar companion to health economics, ed. A.M. Jones. Cheltenham: Edward Elgar.Google Scholar
  20. Smith, J.P. 1999. Healthy bodies and thick wallets: The dual relationship between health and economic status. Journal of Economic Perspectives 13: 145–166.CrossRefGoogle Scholar
  21. Subramanian, S.V., and I. Kawachi. 2003. The association between state income inequality and worse health is not confounded by race. International Journal of Epidemiology 32: 1022–1028.CrossRefGoogle Scholar
  22. Tapia Granados, J. 2005. Recessions and mortality in Spain, 1980–1997. European Journal of Population 21: 393–422.CrossRefGoogle Scholar
  23. Wagstaff, A. 1985. Time series analysis of the relationship between unemployment and mortality: A survey of econometric critiques and replications of Brenner’s studies. Social Science and Medicine 21: 985–996.CrossRefGoogle Scholar
  24. Wagstaff, A., and E. van Doorslaer. 2000. Income inequality and health: What does the literature tell us. Annual Review of Public Health 21: 543–567.CrossRefGoogle Scholar
  25. Wilkinson, R.G. 1992. Income distribution and life expectancy. British Medical Journal 304: 165–169.CrossRefGoogle Scholar
  26. Wilkinson, R.G. 1997. Health inequalities: Relative or absolute material standards. British Medical Journal 314: 591–595.CrossRefGoogle Scholar

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© Macmillan Publishers Ltd. 2018

Authors and Affiliations

  • Christopher J. Ruhm
    • 1
  1. 1.