Stephen A. Bezruchka, MD MPH, Dept. of Health Services, University of Washington, Box 357660, Seattle, WA 98195-7660, (206)616-2901, sabez@u.washington.edu

A critical element of societal structure has been found in recent years to explain many of the differences in health and well-being among populations: how equitably the fruits of society are distributed among its members. This paper will begin by briefly reviewing the current evidence, including plausible biological mechanisms, that links the life expectancy of nations and other groups with measures of equity and hierarchy, such as income distribution, for those populations.

The case study will focus on the effects of inequality in the United States. The health of the people of the US, compared to other countries, has declined over the last 50 years. Currently most of the other rich countries and a few poor ones have better health than that of US residents, no matter which of a wide range of indicators is used. This deterioration in relative health is associated with rising economic inequality over that period in the richest, most powerful country in world history. Although the facts are well known, even at the federal level, they arouse no apparent concern. Likely reasons for this surprising indifference will be discussed.

Learning Objectives: