The indicators tell a story of persistent challenges to achieving health parity.  For example, although the age-adjusted total death rate in King County declined significantly as a whole from 1990 to 2003 and in all racial/ethnic groups except American Indian/Alaska Natives, the gaps in death rates between different groups persisted. Teen birth rates in low, medium and high poverty areas of the county have been decreasing since the early 1990s but are still higher in medium and higher poverty areas than low poverty areas.  Likewise, the number of people reporting restricted activity due to health issues is greater in low-income neighborhoods.  However, the gap in infant mortality rates by neighborhood poverty level appears to be narrowing.  Health disparities by income are less clear with regard to the growing percentage of people who are either overweight or obese.  While other research has shown a strong association between lower incomes and higher obesity rates, this correlation is not seen in King County. 

A widening gap between rich and poor adversely affects the health of the whole community by eroding social cohesion.  Greater inequality in income distribution has been linked to disparities in infant mortality, teen birth rates, as well as violence and mortality rates.  Those living in poverty are more likely to experience chronic stress from unemployment, homelessness and racial and class discrimination, which themselves may lead to adverse health outcomes such as elevated risk of high blood pressure and infant mortality.  Health care access is determined by the neighborhoods one lives in as well as the affordability of health insurance. 

Conversely, having more education increases the chances of finding a living-wage job, having access to high quality health care, and living a healthy lifestyle.  Educational background of the mother is related to childhood access to care, breastfeeding practice, low birth weight and infant mortality.

Washington State’s Department of Health reports several sources of health disparities related to the physical environment in communities. People with lower incomes often live or work in environments where they are exposed to pollution, harmful chemicals and toxins. For example, children who live in older or dilapidated housing can be exposed to indoor allergens and irritants that provoke asthma and increase its severity. Toxic waste sites and other potential environmental hazards are more often sited in low-income neighborhoods.  In addition, tobacco products and alcohol are marketed more aggressively in low-income communities.  People with less education are also more likely to work in jobs associated with increased risk of occupational injury or death.

For example, more preventive care would avert the public dollars poured into amputating limbs on diabetics whose condition has deteriorated to the extent that it can no longer be ignored.  Such examples illustrate that income inequality is both a cause and effect of health inequality: poor people can’t afford good health care and poor health impacts job opportunities.  The good health of both mother and child are critical factors in school readiness, which in turn affects the child’s chances of a successful education and future economic prospects.  Maternal depression, for example, can have significant negative impacts on the physical, intellectual and emotional development of babies as well as older children.

Poor health is also a drain on economic prosperity.  Good health allows us to contribute more fully in our community and at work.  It means fewer days absent at work and school.  And healthier people are less at risk for the potentially disastrous social outcomes of poor health such as bankruptcy and homelessness.