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12/13/2013

Wealth Disparity As A Bioethics Concern

by Craig Klugman, Ph.D.

How much money do you need to live on? $60,000 per year? $40,000 per year? $20,000? Could you live on $11,000 per year? If you made the U.S. Federal minimum wage ($7.25 since 2009) and worked 30 hours per week (the most a large number of employers will permit because anything over and they have to provide health care under the Affordable Care Act) and including no paid vacation or sick time, then you would be earning about $10,875 per year . The U.S. poverty level for a single person is $11,490 and for a family of 4 is $23,550. Nearly 50 million Americans earn les than the poverty level each year. Pope Francis, Time magazine’s Person of the Year, has called on governments to address the wealth gap.

What does this increasing wealth disparity mean for human health? Quite a lot as it turns out. There is a significant association between wealth and health. If you are more educated and wealthier, then you have better health. The same holds true for life expectancy. Wealth disparity=health disparity. Those who are at the bottom (meaning “not in the top 10 percent”) of socioeconomic status are also at the bottom in terms of health indicators and even access to care. This trend is so strong that it cuts across any other indicator such as sex or race/ethnicity.

In the last twenty years, the middle class in the United States has been squeezed to the point where it barely exists. Those people are not moving to higher socioeconomic classes but are joining the ranks of the lower levels. The top one-hundredth of one percent of people make an average of $27 million per household. The bottom 90 percent combined makes an average of $31,244. This translates into 2/3 of all wealth in the U.S. being controlled by the top 10 percent in the socioeconomic ladder. [More statistics on wealth disparities are found here] This gap between rich and poor is the highest it has ever been and is reminiscent of the Gilded Age, a period marked by opulence in the owner-class and severe poverty among workers. It has also been mocked in art such as in the film Elysium where the wealthy actually live in a different world.

After 1969 the minimum wage started falling behind the pace of productivity growth and inflation. If the rate had kept pace, it would have been $18.67 according to the Economic Policy Institute.  President Obama has asked Congress to raise the minimum wage to $10.10. Fast food workers in California have held one-day strikes to support a $15 per hour rate. Business leaders say that won’t happen: Raising the rate that high would raise the cost of doing business. They would hire fewer workers and have to let some of their current ones go.  According to conservative pundits, a raise in the minimum wage would stall economic growth, push businesses to automate jobs currently done by people, increase consumer prices, and decrease the number of jobs available.

However, many states have increased their minimum wage beyond the federal requirement with no significant impact on employment. Beginning in 2014, 21 states including California, New York, New Jersey, Connecticut, Rhode Island, and Illinois have higher rates than the Fed. Two counties in Maryland have increased the rate to $11.50 and the city of SeaTac, Washington raised the rate to $15 for airport and hotel workers.

Others suggest that more money in the pockets of workers gives them more money to spend, thus stimulating economic growth.  The hope is that more money means people can afford to live in healthy environments, eat healthier foods, etc. But this presumes that raising the minimum wage would reduce poverty and assumes that just because those with more wealth enjoy better health, that making people wealthier instantly improves their health.

A search in PubMed for the term “wealth disparity” results in 45 papers.  “Health disparity” brings 320 papers and “social disparity” returns 1,252 items. Wealth/health disparity should be the number one health issue of this century. In his annual peace message, Pope Francis said we need to “avoid the widening gap between those who have more and those who must be content with the crumbs, but above all because it is a question of justice, equality and respect for every human being.” He asked governments to guarantee fundamental human rights, which includes education and access to health care.

Instead of focusing on issues of high technology, medicine and bioethics should be focusing on dealing with this single most significant indicator of health. But as a society, we do not for many reasons. Those with less wealth are less likely to participate in the political process and far less likely to vote in elections.  They are also less likely to provide money to candidates and certainly not enough to compete with the contributions of corporations and wealthy individuals. Dealing with wealth disparities means questioning the fundamental assumptions underlying our society—distribution of goods and services, the free market, and unfettered capitalism. I’m not saying these should be eliminated, but the erosion of protections for the common person should force us to question whether there are fundamental problems with the system and then to address those shortcomings. None of this is easy, nor is it in the interest of those in the upper tiers of socioeconomic wealth or in the halls of power. But sacrificing 90 percent of the population to poor health because of low wealth status is also unacceptable.

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