Bioethics Blogs

The Increasing Divide: How Do We Improve Health In a Stratifying Society?

by Craig Klugman, Ph.D.

While editing a book chapter dealing with public health, I came across the author talking about inequalities in health. Then this followed my morning read of the paper that spoke about the declining middle class. Whereas making it into the middle class is a long-time American dream, the reality is different.

In 1971, the middle class comprised 61% of society. Today, only 49.9% of Americans qualify as being middle class. The rest are either in the upper or lower classes. More of the middle moved into the upper income class than the lower, while the earned income of those in the upper skyrocketed (from 29% of all US income in 1970 to 49% today—though those in the very top brackets make most of their money from sources other than income). But for those in the middle and lower income classes, aggregate income decreased. The Pew Research Forum, which conducted the study, cites this as evidence of the growing income divide in the U.S.: the rich get richer, the poor get poorer and the middle class disappears.

At the same time, the ability to move up from class to another has gotten more difficult. The U.S. is one of the most socially immobile countries in the industrialized world.

In public health circles, it is known that there is a strong correlation between health (longevity, chronic disease loads, disability, and acute illness) and income. People with higher incomes usually have better resources (insurance and cash) to access medical services. They can afford more nutritious food that is usually available close to home and they live in safe neighborhoods with plenty of facilities for exercise.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.