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. 2004 Mar;58(3):175–179. doi: 10.1136/jech.2003.008672

The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities

C Ronzio 1, E Pamuk 1, G Squires 1
PMCID: PMC1732695  PMID: 14966226

Abstract

Objective: To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities.

Design: Cross sectional ecological study.

Outcome measures: All cause death rates and death rates attributable to preventable or immediate causes for people under age 75.

Predictor measures: Income inequality, city spending, and social factors.

Setting: All central cities in the US with population equal to or greater than 100 000.

Results: Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads.

Conclusions: Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time.

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Selected References

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  1. Blakely Tony A., Lochner Kimberly, Kawachi Ichiro. Metropolitan area income inequality and self-rated health--a multi-level study. Soc Sci Med. 2002 Jan;54(1):65–77. doi: 10.1016/s0277-9536(01)00007-7. [DOI] [PubMed] [Google Scholar]
  2. Brown L. D. Urban health policy. J Urban Health. 1998 Jun;75(2):273–280. doi: 10.1007/BF02345096. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Diez Roux A. V. Investigating neighborhood and area effects on health. Am J Public Health. 2001 Nov;91(11):1783–1789. doi: 10.2105/ajph.91.11.1783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fiscella K., Franks P. Poverty or income inequality as predictor of mortality: longitudinal cohort study. BMJ. 1997 Jun 14;314(7096):1724–1727. doi: 10.1136/bmj.314.7096.1724. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Judge K. Income distribution and life expectancy: a critical appraisal. BMJ. 1995 Nov 11;311(7015):1282–1287. doi: 10.1136/bmj.311.7015.1282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Judge K., Mulligan J. A., Benzeval M. Income inequality and population health. Soc Sci Med. 1998 Feb-Mar;46(4-5):567–579. doi: 10.1016/s0277-9536(97)00204-9. [DOI] [PubMed] [Google Scholar]
  7. Kaplan G. A., Pamuk E. R., Lynch J. W., Cohen R. D., Balfour J. L. Inequality in income and mortality in the United States: analysis of mortality and potential pathways. BMJ. 1996 Apr 20;312(7037):999–1003. doi: 10.1136/bmj.312.7037.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kaplan G. A. Socioeconomic considerations in the health of urban areas. J Urban Health. 1998 Jun;75(2):228–235. doi: 10.1007/BF02345090. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kawachi I., Kennedy B. P., Lochner K., Prothrow-Stith D. Social capital, income inequality, and mortality. Am J Public Health. 1997 Sep;87(9):1491–1498. doi: 10.2105/ajph.87.9.1491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kennedy B. P., Kawachi I., Prothrow-Stith D., Lochner K., Gupta V. Social capital, income inequality, and firearm violent crime. Soc Sci Med. 1998 Jul;47(1):7–17. doi: 10.1016/s0277-9536(98)00097-5. [DOI] [PubMed] [Google Scholar]
  11. Lynch J. W., Kaplan G. A., Pamuk E. R., Cohen R. D., Heck K. E., Balfour J. L., Yen I. H. Income inequality and mortality in metropolitan areas of the United States. Am J Public Health. 1998 Jul;88(7):1074–1080. doi: 10.2105/ajph.88.7.1074. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lynch J. W., Smith G. D., Kaplan G. A., House J. S. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ. 2000 Apr 29;320(7243):1200–1204. doi: 10.1136/bmj.320.7243.1200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lynch J., Smith G. D., Hillemeier M., Shaw M., Raghunathan T., Kaplan G. Income inequality, the psychosocial environment, and health: comparisons of wealthy nations. Lancet. 2001 Jul 21;358(9277):194–200. doi: 10.1016/S0140-6736(01)05407-1. [DOI] [PubMed] [Google Scholar]
  14. Lynch John, Smith George Davey. Commentary: Income inequality and health: the end of the story? Int J Epidemiol. 2002 Jun;31(3):549–551. doi: 10.1093/ije/31.3.549. [DOI] [PubMed] [Google Scholar]
  15. Muntaner C., Lynch J. Income inequality, social cohesion, and class relations: a critique of Wilkinson's neo-Durkheimian research program. Int J Health Serv. 1999;29(1):59–81. doi: 10.2190/G8QW-TT09-67PL-QTNC. [DOI] [PubMed] [Google Scholar]
  16. Muntaner C., Lynch J. Income inequality, social cohesion, and class relations: a critique of Wilkinson's neo-Durkheimian research program. Int J Health Serv. 1999;29(1):59–81. doi: 10.2190/G8QW-TT09-67PL-QTNC. [DOI] [PubMed] [Google Scholar]
  17. Muntaner C., Lynch J., Smith G. D. Social capital, disorganized communities, and the third way: understanding the retreat from structural inequalities in epidemiology and public health. Int J Health Serv. 2001;31(2):213–237. doi: 10.2190/NVW3-4HH0-74PX-AC38. [DOI] [PubMed] [Google Scholar]
  18. Ross N. A., Wolfson M. C., Dunn J. R., Berthelot J. M., Kaplan G. A., Lynch J. W. Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics. BMJ. 2000 Apr 1;320(7239):898–902. doi: 10.1136/bmj.320.7239.898. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Royer C. T. The state and local political environment of urban health. J Urban Health. 1998 Jun;75(2):294–299. doi: 10.1007/BF02345098. [DOI] [PMC free article] [PubMed] [Google Scholar]

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