What We Earn
Income influences health at every income level. It may come as little surprise that the wealthiest people in American are healthier than the poorest. They are also healthier than the middle-class.
People with less incomes have shorter lives, poorer self-reported physical and emotional health, and more chronic disease than their high-income counterparts. For example, of people in America reporting being in poor or fair health: 23 percent had annual incomes below $35,000, with 9 percent who earned $50,000–$75,000 and just 6 percent earning more than $100,000.
People with less income and wealth are less able to pay for health care or health insurance. They are also less likely to afford an education, healthy lifestyles, or to live in safe and healthy neighborhoods. Economic hardship makes people more vulnerable to diseases and to the harmful biological effects of stress.
What We Learn
People in America with higher education levels have longer lifespans and suffer from fewer chronic diseases. For example, male college graduates in 2008 can expect to live 14 years longer than males without a high school diploma; females in this same comparison can expect to live more than 10 years longer.
Education is linked to financial, social, psychological, and cognitive benefits that promote better health. In fact, these links appear to be growing stronger over time: The life expectancy of whites with less than 12 years of school has decreased since 1990 even as it increased for other people.
The education-link cuts across race, ethnicity, and gender, and is so strong that educational attainment may be more important for health outcomes than quality health care. For example, one study found that Kaiser Permanente health plan members with less schooling have lower self-reported health levels and higher diabetes mortality rates, even though all members have the same access to care.
Where We Work
For millions of people, a steady job in safe working conditions can provide the income, benefits, and stability necessary for good health. On the flip side, job loss and unemployment is associated with a variety of negative health effects. For example, laid-off workers are 54 percent more likely than those continuously employed to report fair or poor health, and are 83 percent more likely to develop a stress-related condition such as stroke or heart disease.
When it comes to promoting health, not all employment is equal. Health insurance is more likely to be offered to employees earning higher salaries. Some employers offer workplace wellness programs, which studies show save employers an average of $6 for every dollar invested.
Our nation has worked over the past few years to improve health primarily through improving the health care system, focusing less on other critical factors that impact health, such as early childhood development, education, housing, jobs, and the built environment.
There is no doubt that a quality health care system remains critically important. Everybody, regardless of socioeconomic status, will at some point require health care. This is especially true of children and the elderly, who have the most to gain from a reliable health care system. Furthermore, more efficient and transparent health care spending will result in a system that serves the population more effectively, while allowing for people to be educated about where their health care dollars are being spent.
But a more efficient and transparent health care system is only one piece of the puzzle. That’s why the Robert Wood Johnson Foundation is promoting a Culture of Health, which means creating a society where every person has the equal opportunity to live the healthiest life they can, whatever their ethnic, geographic, racial, socioeconomic, or physical circumstance.
Everyone has a role to play in building a Culture of Health, and success will require working within and across all sectors of society. RWJF is partnering with communities, policymakers, businesses, and others willing to find ways to build a Culture of Health for America. The RWJF County Health Rankings & Roadmaps’ What Works for Health helps communities bring together people from a variety of sectors to look at the many factors that influence health and learn from one another about strategies that will have lasting impact (e.g., policies, programs, systems & environmental changes).
We have developed a Culture of Health Action Framework with the RAND Corporation and with input from partners, experts, and colleagues across the country. The Framework describes the fundamental components to improving population health and motivating cultural change.
With the Action Framework as a compass, we will work with others to advance efforts to improve health nationwide and measure our success.