Health Inequality
How your zip code predicts your lifespan more than your genetic code, and why the health gap mirrors the wealth gap.
The Social Gradient of Health
Health follows a social gradient: the richer you are, the healthier and longer-lived you are, at every point on the income scale. In the United States, men in the top 1% of income live an average of 15 years longer than men in the bottom 1%. This gap is not primarily about access to healthcare -- it reflects the cumulative impact of living conditions, stress, nutrition, environmental exposure, and health behaviors that differ systematically by income.
The Marmot Review, led by epidemiologist Michael Marmot, demonstrated that the health gradient exists even within affluent populations. Among British civil servants -- all employed, all with access to the National Health Service -- those in lower-ranking positions had significantly worse health outcomes than those in senior positions. This suggests that social hierarchy itself, through mechanisms like chronic stress and sense of control, affects health independently of material deprivation.