Money is injurious to health

This report explores the role of ‘money’ for people’s health. Understanding the importance of money for health is crucial as reducing inequalities in health is a key government policy across the UK, and reducing poverty and improving family incomes are often seen as key components of such policies.

Introduction

Evidence about the association between income and health, both at one point in time and over time, can be found in a wide range of disciplines. However, there is much debate about the specific causal pathways that link people’s income and health and the two key concepts – income and health – are both defined and measured in a wide range of ways. Given this complexity, a systematic theoretical review has been conducted to develop a better understanding of how income and health are related over the life course.

Psychosocial pathways

Psychosocial mechanisms are a result of the way in which people’s social environment makes them feel. Two broad paths are believed to link people’s financial situation to their health. The first is that living on low income is stressful. At the same time people in disadvantaged situations may have less support to draw on to help them cope with difficult circumstances. The second path has a relative or comparative dimension; feelings of lower status than others in society, because of less money, make people feel distressed. Increasingly, biological research is providing evidence that shows how such ‘feelings’ can get ‘under the skin’ to cause biochemical changes in the body, which when experienced repeatedly, can cause damage to physiological systems and hence lead to poor health.

Behavioural pathways

Many negative health behaviours are more prevalent among socially disadvantaged groups. A number of specific mechanisms have been proposed to explain this. First, some healthy behaviours are expensive, for example a healthy diet has been shown to be more expensive than an unhealthy one, joining a gym or taking part in extra school sporting clubs can be costly. Second, people may use some unhealthy behaviours such as smoking or drinking alcohol as a way of coping with difficult situations. A linked argument is that the difficulties of coping with life on low incomes inclines people to discount the future more heavily, meaning people are less concerned with the long-term health-damaging effects of behaviours that bring them current pleasure or stress relief. The cultural context of the lives of people with different income levels may differ, for example the degree to which unhealthy behaviours are socially acceptable or the extent to which health-promoting messages to change behaviours are adopted. Understanding this broader context, together with the different mechanisms that lead people on low incomes to engage in unhealthy behaviours, helps to explain why it is difficult to improve health behaviours without addressing these multiple reasons for the behaviour.

Poor health leads to low income

Health selection theory describes how people’s health influences their income. The most direct route is that ill health prevents someone from undertaking paid employment, which reduces their income. More long term ill health in childhood may influence educational outcomes which in turn affects employment opportunities and earning potential later in life. There are also more subtle mechanisms. For example a significant literature exists that suggest that people’s health, in particular obesity, height and physical appearance, can influence economic outcomes such as employment opportunities or wages. The hypothesised mechanism is that gatekeepers to such opportunities subconsciously associate being slim or tall or attractive with other positive attributes that they value.

Other pathways

Some researchers have argued that the association between income or money and health is actually caused by a third factor affecting both of them. Two key candidates put forward in the literature are intelligence and personality. For example, it has been argued that intelligence may lead to both educational advantage and socioeconomic success as well as more health-promoting behaviour and hence good health.

Conclusions

Many previous studies of income and health tested relationships associated with a particular theory or attempted to compare the relative merits of ‘rival’ theories. In contrast, this review emphasises the interdependence of mechanisms. There is no specific pathway or mechanism that dominates the explanation, the pathways link to each other and interact across people’s lives in multiple ways that influence health. This implies that broad-ranging policies are required to address health inequalities. There is, however, a particular emphasis on the importance of parental income for both their children’s health during childhood and also the long-term consequences of their future social economic and health circumstances. Further, health improvement policies that rely only on initiatives that target specific risk factors or deliver single interventions are in danger of being insufficiently comprehensive to yield anything more than modest benefits.